A bit on the side. Adjunctive treatments for type 1 diabetes

For decades type 1 diabetes has been viewed almost exclusively through an immunological lens, with insulin as the sole pillar of survival. However, as the diabetes care team knows, insulin alone often falls short of physiologic perfection. This live CME session explores a fundamental shift in philosophy, treating type 1 not just as an autoimmune deficiency, but as a complex metabolic disorder requiring multi-pathway intervention.

We will delve into the emerging clinical landscape of adjunctive therapies, moving beyond the ‘insulin-only ‘dogma. Central to our discussion is the potential of GLP-1 Receptor Agonists as potential game changers. By targeting glucagon suppression & slowing gastric emptying, GLP-1 RAs address the postprandial glycaemic excursions that insulin often struggles to tame. Evidence suggests these agents can reduce total daily insulin doses & body weight without increasing the risk of severe hypoglycaemia.

Furthermore, we will explore the provocative concept of beta-cell metabolic fitness. New research suggests that stressed beta cells actively contribute to their own destruction through glucotoxicity & endoplasmic reticulum stress. By utilizing metabolic interventions such as verapamil to preserve C-peptide or SGLT inhibitors to reduce glucose variability, we may be able to shield remaining beta-cell function.

Philosophically, this represents a transition from established replacement therapy to metabolic preservation. It challenges us to view the patient’s physiology not as a broken machine to be fuelled, but as a biological system to be stabilized & protected.