Pharmacological Management of Type 1 Diabetes

Type 1 diabetes mellitus is lack of endogenous insulin production by β cells of islets of Langerhans. Genetic susceptibility and environmental influence develop autoimmunity against β cells and insulin itself. Thereby gives destruction of β cell mass and absence of insulin production. Today incidence of type 1 diabetes mellitus has reached 7% of the population in United States and steadily rising 3–5% annually. The first option and necessary treatment of type 1 diabetes is insulin replacement therapy. It is an essential treatment to replace endogenous insulin by giving exogenous insulin in combination of drugs with different durations. Throughout this intensive insulin therapy the individual is expected to have sufficient glycemic control to prevent from acute, chronic complications of type 1 diabetes. However, diabetes mellitus is still the leading cause of blindness, end-stage renal disease and non-traumatic lower extremity amputation in the United States. Also for those who were in intensive insulin therapy had threefold increase in the risk of hypoglycemia and 30% higher risk of developing overweight. Moreover DEPAC survey mentioned, among 10000 individuals only 13.1 % were in the target HbA1C level which highlights the fact of limitation in insulin monotherapy. And emphasizing the need of adjunct therapy in order to give the individual a better quality of life. Glucagon-like peptide-1 receptor agonist showed potential to adjunct therapy of type 1 diabetes. It is currently used in type 2 diabetes giving increase insulin secretion by improving insulin resistance, β cell proliferation and reducing glucagon secretion and significant weight loss. As it is, glucagon-like peptide-1 receptor agonist could benefit type 1 diabetes as well. To see the efficacy and safety of glucagon-like peptide-1 receptor agonist researches were design and performed. In conclusion adjunctive therapy of exenatide and liraglutide gave improvement of glycemic control, significant weight loss and decrease in insulin dose. Some reports suggested of no significant glycemic improvement but definite weight loss was demonstrated in all cases. Even though more research is required, nevertheless glucagon-like peptide-1 receptor agonist has promising role in type 1 diabetes as adjunct therapy to insulin monotherpy. egységes, osztatlanáltalános orvosango