Drug for type 2 diabetes provides significant benefits to type 1 diabetic patients

September 14, 2017, University at Buffalo
Credit: CC0 Public Domain

A majority of patients with Type 1 diabetes who were treated with dapagliflozin, a Type 2 diabetes medicine, had a significant decline in their blood sugar levels, according to a new study published in The Lancet Diabetes and Endocrinology. The results are being presented today by the University at Buffalo researcher who led the study at the annual meeting of the European Association for the Study of Diabetes in Lisbon.

Called DEPICT-1, which stands for Dapagliflozin in Patients with Inadequately Controlled Type 1 , the 24-week study was the first global multicenter investigation of dapagliflozin to test its efficacy and safety in Type 1 diabetes. The double-blind, randomized, three-arm, phase 3 multicenter study was conducted at 143 sites in 17 countries, including the U.S. It was funded by AstraZeneca and Bristol-Myers Squibb, the companies that partnered to develop dapagliflozin.

Participants were 833 aged 18-75 who had inadequately controlled blood sugars with a mean baseline hemoglobin A1C (HbA1c)—a measure of sugar in the blood—level of 8.53. A1C levels for Type 1 diabetics are considered optimal when they are under seven.

Adjunct to insulin

The results demonstrate that when this drug, a sodium glucose cotransporter-2 inhibitor (SGLT-2) was administered as an adjunct therapy in addition to the insulin that patients with Type 1 diabetes need to survive, it significantly improved outcomes.

"Our paper provides the initial signal that dapagliflozin is safe and effective in patients with Type 1 diabetes and is a promising adjunct treatment to insulin to improve glycemic control," said senior author Paresh Dandona, MD, PhD, SUNY Distinguished Professor and chief of endocrinology, diabetes and metabolism in the Department of Medicine in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

"The 24-week results from DEPICT-1 are important as they represent the first Phase 3 trial in Type 1 diabetes of the newer, selective SGLT-2 class of diabetes medicines as an oral adjunct to insulin," he said.

In the study, approximately half of the patients taking dapagliflozin reduced their A1C levels by more than 0.5 percent without experiencing severe drops in (hypoglycemia). Dandona explained that any fall in HbA1c of around .5 percent is considered significant and can lead to licensing of a drug as an antidiabetic agent. He noted, however, that the findings will need further confirmation before the drug can be licensed by the FDA for use in Type 1 diabetes.

Better control in Type 1 diabetes

"Treating the millions of patients living with Type 1 diabetes while also managing the complications associated with the disease remains a daunting challenge," said Dandona, who sees patients through UBMD Internal Medicine at the Diabetes and Endocrinology Center of Western New York, which is where the five Buffalo patients in the study were treated.

He is renowned for his diabetes and metabolic research, particularly into new treatments that can be used in addition to insulin, to help patients with Type 1 diabetes achieve better blood sugar control. He has led the field globally since his published work on liraglutide patients with Type 1 diabetes in 2011.

In 2011, Dandona published an observational study that found that another drug for Type 2 diabetes, liraglutide, could help treat Type 1 diabetes.

"Our key paper in 2011 has led to other drugs being considered for use in Type 1 diabetes," he said. "We have been pioneers in conceptualizing new ways to help Type 1 achieve better outcomes with new therapies."

Dandona pointed out that until these recent developments, there hadn't been another significant treatment developed for Type 1 diabetes since the discovery of insulin in the 1920s.

Even Type 1 patients with good glycemic control experience what he calls "glycemic excursions," pronounced swings from hyperglycemic to hypoglycemic, motivating him and his colleagues to conduct groundbreaking research aimed at discovering non-insulin drugs that can help improve .

No ketoacidosis

An interesting aspect of the current study is that contrary to Dandona's earlier pilot study with dapagliflozin, there was no finding of ketoacidosis, a dangerous complication that occurs when acids and substances called ketones build up in the blood due to lack of insulin. "We found out that any reduction of insulin dose greater than 20 percent, or the absence of a meal and missing the dose, or the significant intake of alcohol makes you more vulnerable to ketoacidosis," he explained, noting that since these issues were avoided in the DEPICT-1 study, no increase in ketoacidosis was observed.

Dandona and his co-authors are awaiting the final results of the DEPICT-1 patients at 56 weeks. "If the outcomes are sustained or better at that time, and if a parallel study, DEPICT-2, confirms this, there will likely be an application to the FDA for licensing the drug for use in Type 1 diabetes," he said.

Explore further: Combination therapy for type 1 diabetes improves blood glucose control

Related Stories

Combination therapy for type 1 diabetes improves blood glucose control

August 4, 2016
A combination of three medications—dapagliflozin, liraglutide and insulin—helped people with Type 1 diabetes improve blood sugar control and lose weight, according to a new study published in the Endocrine Society's Journal ...

New oral diabetes drug shows promise in phase 3 trial for patients with type 1 diabetes

September 13, 2017
A University of Colorado Anschutz Medical Campus study finds sotagliflozin helps control glucose and reduces the need for insulin in patients with type 1 diabetes.

In T2D, glycemic control up with continuous glucose monitoring

August 23, 2017
(HealthDay)—Adults with type 2 diabetes receiving multiple daily insulin injections randomized to continuous glucose monitoring (CGM) have improved glycemic control versus usual care, according to a study published online ...

Dapagliflozin aids glycemic control in type 2 diabetes

March 20, 2012
(HealthDay) -- For patients with inadequately controlled type 2 diabetes, treatment with dapagliflozin is associated with improved glycemic control, stabilized insulin dosing, and weight reductions, according to research ...

Liraglutide with insulin improves poorly controlled Type 1 diabetes

June 25, 2012
Obese adults with poorly controlled Type 1 diabetes can better control their blood sugar by adding liraglutide, a Type 2 diabetes drug, to their insulin therapy, a new study finds. The results, which will be presented at ...

Study suggests drug significantly improves glycemic control in type one diabetics on insulin

June 15, 2011
Results of a small, observational study conducted at the University at Buffalo suggest that liraglutide, an injectable medication used to treat type 2 diabetes, also helps type 1 diabetics on insulin achieve optimal control ...

Recommended for you

Genetic discovery may help better identify children at risk for type 1 diabetes

January 17, 2018
Six novel chromosomal regions identified by scientists leading a large, prospective study of children at risk for type 1 diabetes will enable the discovery of more genes that cause the disease and more targets for treating ...

Thirty-year study shows women who breastfeed for six months or more reduce their diabetes risk

January 16, 2018
In a long-term national study, breastfeeding for six months or longer cuts the risk of developing type 2 diabetes nearly in half for women throughout their childbearing years, according to new Kaiser Permanente research published ...

Women who have gestational diabetes in pregnancy are at higher risk of future health issues

January 16, 2018
Women who have gestational diabetes mellitus (GDM) during pregnancy have a higher than usual risk of developing type 2 diabetes, hypertension, and ischemic heart disease in the future, according to new research led by the ...

Diabetes gene found that causes low and high blood sugar levels in the same family

January 15, 2018
A study of families with rare blood sugar conditions has revealed a new gene thought to be critical in the regulation of insulin, the key hormone in diabetes.

Discovery could lead to new therapies for diabetics

January 12, 2018
New research by MDI Biological Laboratory scientist Sandra Rieger, Ph.D., and her team has demonstrated that an enzyme she had previously identified as playing a role in peripheral neuropathy induced by cancer chemotherapy ...

Enzyme shown to regulate inflammation and metabolism in fat tissue

January 11, 2018
The human body has two primary kinds of fat—white fat, which stores excess calories and is associated with obesity, and brown fat, which burns calories in order to produce heat and has garnered interest as a potential means ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.