OR08-08 Evaluating the Clinical Use of Verapamil in Type 1 Diabetes: A Real-World Experience

Abstract Disclosure: T. Akcan: None. R.S. Kingman: None. B. Suh: None. K. Kingston: None. Y. Liu: None. M. Morgan: None. M. Lee: None. B. Buckingham: None. M.S. Hughes: None. R.A. Lal: None. Background: Verapamil, a calcium channel blocker, has emerged as a potential beta-cell preservation therapy for Type 1 Diabetes (T1D). Real-world data on the implementation of verapamil remains limited. This study evaluates the clinical use of verapamil at a single academic medical center. Methods: A retrospective chart review was conducted on individuals with T1D who were considered for verapamil therapy. Those included were categorized into two groups: individuals who initiated verapamil and those who discussed but did not proceed with treatment. Data collected included demographics, adherence to monitoring protocols (creatinine, AST, ALT, and ECGs), ability to reach the recommended maximum dose (weight-based to a maxiumum of 360 mg/day for individuals ≥50 kg), adverse events and barriers to therapy. Results: A total of 75 individuals with T1D, age 2-76 years, were considered for verapamil therapy. Among the 33 (44%) who initiated treatment (age 26.1±18.0 years), screening labs were completed in 90.9% (30/33), and ECGs were performed in 66.7% (22/33) prior to therapy initiation. The mean PR interval on screening ECG were normal (143 ± 22 msec). A total of 72.7% (24/33) reached the recommended maximum dose. Among these, 58.3% (14/24) completed follow-up labs. Another 58.3% (14/24) had repeat ECGs two weeks after reaching maximum dose, with a normal mean PR interval at follow-up of 147 ± 24 msec. Adverse events attributed to verapamil were reported in four individuals. These included one case of mild constipation and two cases of temporary PR prolongation over 200 msec, both of which resolved, allowing them to continue on the maximum recommended dose. One adolescent missed doses, took extra to compensate (at least 720 mg) and developed symptomatic heart block requiring hospitalization in the Cardiac ICU. The family elected to stop verapamil. Notably, four individuals weighing <30 kg were treated with 60 mg/day, maintained normal ECGs on this dose and have successfully continued treatment. In contrast, 42 individuals (56%) discussed verapamil, with documentation in the chart, but did not initiate therapy (mean age 20.7 ± 17.5 years). Reasons for non-initiation were recorded in 16 (38.1%) cases. Among these, 62.5% (10/16) cited personal preference, the need for more time to consider therapy, or verapamil was prescribed but not started; 18.8% (3/16) were ineligible due to screening lab results, and 18.8% (3/16) were deemed too young and/or with a weight below 30 kg. Conclusion: Despite being among the simplest beta-cell preservation therapies, real-world implementation of verapamil in T1D under current protocols presents challenges. Modifiable barriers to initiation include individual/provider preferences, protocol and logistical constraints. Education around missed doses is imperative. Simplified approaches to dosing and monitoring may improve accessibility for a broader population. Presentation: Saturday, July 12, 2025