(DCP068) A COMPARATIVE STUDY ON THE USE OF GLUCOSE-LOWERING AGENTS AS ADJUVANT THERAPY IN PATIENTS WITH TYPE 1 DIABETES MELLITUS

Background: Attaining optimal glucose control is a challenge for many people with type 1 diabetes (PwT1D). Adjuvant glucose-lowering drugs such as metformin, Glucagon-Like Peptide-1 receptor agonists (GLP1-RA), and Sodium Glucose Co-transporter 2 inhibitors (iSGLT2), although mostly off-label, are used by PwT1D to improve health outcomes. We compared socio-demographic and disease-related characteristics of PwT1D using these drugs and of non-users.

METHODS AND RESULTS: Cross-sectional study using self-reported data from adult PwT1D in the BETTER registry including demographic and T1D characteristics, treatment modality and complications and Body Mass index (BMI). Categorical variables were analyzed using the Chi square test and non-normally distributed continuous variables were analyzed using the Mann-Whitney U test.
In the 594 participants included in the analysis (63.1% women, median [IQR] age 44.0 years [19.0, 69.0], BMI 25.7 kg/m2 [19.7, 31.7], 22.2% with HbA1c < 7.0%, 36.5% insulin pump users), 15.5% of participants (n = 92) reported using adjuvant medication (metformin 51.0%; iSGLT2 31.5%; GLP1-RA 28.3%). Users of adjuvant therapy were older (median [IQR] age 48.0 [32.0, 64.0] vs. 43.0 [17.0, 69.0], p = 0.004), had higher BMI (median [IQR] 29.4 [21.4, 37.4] vs. 25.2 [20.2, 30.2], p < 0.001), reported using more insulin: rapid-acting (median [IQR] 30.0 [6.0, 54.0] vs. 21.0 [3.0, 39.0] UI/day, p = 0.008), and for multiple daily injection users long acting insulin (median [IQR] 26.0 [1.0, 51.0] vs. 17.0 [4.0, 30.0] UI/day, p = 0.001) than non-users. Using adjuvant therapy was also associated with presence of dyslipidemia (54.4% vs. 41.7%, p = 0.025), cardiovascular diseases (15.2% vs. 7.0%, p = 0.009), thyroid disease (37.4% vs. 27.1%, p = 0.045), and their cardiorenal treatments (antihypertensive [44.6% vs. 29.9%, p = 0.006], lipid-lowering drugs [62.0% vs. 44.2%, p = 0.002]), compared to non-users. No significant difference was observed between the two groups for HbA1c level, other demographic characteristics, hypoglycemic episodes and other diabetic complications.

Conclusion: The use of glucose-lowering drugs as adjuvant therapy is not marginal in adult PwT1D. Worse cardiometabolic potential may drive the prescription of adjuvant therapy.