A new triple therapy approach found to reduce HbA1c in type 1 diabetes
A combination of three therapies, according to a new study, can help get blood glucose levels under control, and help to lose weight, in overweight or obese patients with type 1 diabetes.
In a trial of thirty people, a combination of insulin, liraglutide and dapagliflozin was found to have a higher rate of benefits than just an insulin/liraglutide therapy.
All of the participants in the study were taking insulin and liraglutide before the trial began, and then researchers randomised whether they would receive a placebo or dapagliflozin.
Continuous glucose monitors were used to track the blood sugar levels of the participants at all times, in order to give the researchers a clear and comprehensive picture of what effect the drug combination was having.
At the beginning of the study, the group assigned dapagliflozin had an average body weight of 85kg compared to 79kg in the placebo group. HbA1c levels at the start of the study were 7.8% in the dapagliflozin group and 7.4% in the placebo group.
In the patients who were taking the triple therapy, HbA1c fell by 0.66%, while no significant change was recorded in the control group. Bodyweight fell by just 0.7kg in the control group, whereas it fell by 1.9kg in the triple therapy group.
Two of the participants who were given the triple therapy rather than the placebo developed ketoacidosis during the trial, and so were immediately removed. Another two participants failed to complete the study, leaving 26 viable participants.
“Our research found a triple therapy (insulin, liraglutide and dapagliflozin) approach led to impressive improvements in blood glucose control as well as weight loss. This strategy advances our previous work showing improvements in blood glucose management with the use of liraglutide in combination with insulin,” said the study’s senior author, Doctor Paresh Dandona, of the University at Buffalo, New York.
Dandona added: “Our data also show for the first time that all patients on dapagliflozin experience an increase in ketones. This may predispose people to developing diabetic ketoacidosis, particularly among those who have a marked reduction in insulin from taking liraglutide together with dapagliflozin and who have consumed too few carbohydrates. On the basis of the data, the dose reduction of insulin should be minimized and the higher dose of dapagliflozin should not be used in such patients. Our study sheds light on potential strategies for preventing diabetic ketoacidosis, but more research is still needed in this area.”
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