Adjunctive diabetes therapies and cardiovascular protection in type 1 diabetes: tackling the challenging Tchaikovsky piece

The most widely studied adjunctive diabetes agent for type 1 diabetes is metformin. Meta-analyses suggest that metformin modestly improves glucose control, weight, lipid profile, and carotid intima-media thickness in patients with type 1 diabetes and mild obesity. SGLT2 inhibitors have been shown to modestly improve glycaemic control, weight, and blood pressure but are associated with increased risk of diabetic ketoacidosis in individuals with type 1 diabetes. The use of GLP-1 RA in type 1 diabetes with mild obesity provided modest HbA1c and weight reduction, but gastrointestinal side effects were common. The results of the ongoing phase 3 clinical trial of finerenone study in type 1 diabetes on chronic kidney disease progression are awaited. Observational studies suggest that CSII and CGM may also reduce cardiovascular events and hospitalizations in patients with type 1 diabetes.