A Novel Paradigm for Adult‐Onset Type 1 Diabetes: Once‐Weekly Basal Insulin and SGLT‐2 Inhibition to Harness Residual β‐Cell Function
Paolo Pozzilli, Richard David LeslieABSTRACT
Type 1 diabetes (T1D) in adults is characterised by a less aggressive disease course than in children. Most patients retain preserved C‐peptide (> 02 nmol/L) and some of them benefit from a protracted phase without the need for insulin. Here, we propose a hypothesis‐generating therapeutic paradigm with once‐weekly basal insulin combined with an SGLT2 inhibitor (SGLT2is) as initial therapy in T1D patients with preserved C‐peptide. Once‐weekly basal insulin, approved in Europe and now also in the US, confirm comparable HbA1c reductions to insulin degludec or glargine, albeit always alongside prandial insulin. SGLT2is, approved as adjuncts in T1D in select regions, can control prandial peaks without boluses. No trials have tested the combination of weekly insulin with SGLT2is in adult T1D patients. Nonetheless, the rationale is robust especially in adults with C‐peptide > 0·2 nmol/L. In this respect, we urge proof‐of‐concept trials of 12‐months randomised studies in adults ≥ 18 years, to evaluate this combination.