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The role of oral hypoglycemic agents in management of type 1 diabetes; a personal clinical experience
Gabriel I. Uwaifo, MDa, Shreya Patel, MDb, Christian A. Koch, MD, PhDb
a; Endocrinology Division, Dept of Medicine, Louisiana State University Health Sciences Center-NO, b; Endocrinology Division, Dept of Medicine, University
of Mississippi Medical Center

Introduction/Background; Results; Basic demographics Results;

Effects of OHA use on type 1 diabetic subjects
Basic Demographics Chart of type 1 cohort
The prevalence of Diabetes is increasing worldwide and here in the United
States. While this is largely due to increased incidence of type 2 diabetes Parameter General cohort Type 1 on Type 1 on insulin + P value
Parameter Before OHA use While on OHAs P value

secondary to the twin obesity epidemic the prevalence of type 1 diabetes is also injectables only
(Insulin Symlin)
oral hypoglycemic
agents (OHAs)
HBA1c (%) 8.6 0.9 7.7 0.65 *
increasing. Number 212 174 38
Age 42.7 3.8 39.8 9.2 40.4 5.6
Weight (kg) 92 16.3 89 14.9
Gender distribution 120 women 92 97 women 77men 22 women 16
Type 1 diabetes which is primarily insulinopenic in etiology (and often of
2
men men BMI (kg/m ) 34.2 15.8 32.4 14.4
Ethnicity 68% Cauc. 30% Afr 70% Cauc. 30% Af. 55% Cauc. 35% Af.
autoimmune basis) is exclusively managed with insulin hence its older moniker Am 2% other Am Am 10% other Total insulin dose (units/day) 64.7 17.4 53.6 12.3 *
of insulin dependent diabetes mellitus (IDDM). HBA1c 8.4 0.7 8.2 0.8 8.6 0.9
Systolic blood 134.7 15.3 138 12.4 136. 4 16.4 Systolic blood pressure 136.4 16.4 138 24.7
pressure (mmHg) (mmHg)
Pramlintide (a synthetic analog of the beta cell peptide hormone Symlin) is the Diastolic blood 67 3.7 71.3 5.6 69.6 7.4 Diastolic blood pressure 69.6 7.4 70.3 8.9
pressure (mmHg) (mmHg)
only other available treatment adjunct available for management of type 1 Resting pulse rate 78.6 12.2 82.4 9.5 80.3 9.7
Pulse rate (bpm) 80.3 9.7 77.3 8.9
(bpm)
diabetes Total Cholesterol 156 42.5 150.6 38.2 161.3 43.4
Reported hypoglycemia ~ 4-6 separate SMBG Essentially unchanged except
(mg/dl)
records/week with 1-3 severe in Acarbose and Colesvalam
While insulin replacement therapy is the ideal treatment strategy for type 1 HDL cholesterol
(mg/dl)
42.5 8.7 45.5 9.3 41.9 7.7
episodes per month treated patients who
diabetes, ideal insulin replacement therapy in type 1 diabetes is often difficult LDL Cholesterol 124 35.7 119 27.6 130 33.8 reported less events
(mg/dl) Total cholesterol (mg/dl) 161.3 43.4 159.7 61.4
and fraught with the danger of significant hypoglycemia and less commonly the Triglycerides (mg/dl) 140.4 17.8 138.7 21.6 142.5 14.8
concern of attendant secondary weight gain. Weight (Kg)
2
86 12.5 77 15.6 92 16.3 * HDL cholesterol (mg/dl) 41.9 7.7 44.3 8.7
BMI (kg/m ) 31.5 18.4 27.4 12.6 34.2 15.8 *
Mean Insulin dose 53.2 16.4 48 13.9 64.7 17.4 * LDL Cholesterol (mg/dl) 130 33.8 128 42.5
Inadequate insulin replacement therapy in type 1 diabetes can also result in (units/day)
On insulin pump 41 41 0
wide, severe glycemic swings that belie the brittle glycemic profile of some On Mixed split 171 133 38
Triglycerides (mg/dl) 142.5 14.8 139.3 12.6

insulin regimen
patients with type 1 diabetes and may be associated with higher risk for end
*= P values < 0.05 Data presented with Standard deviations when available
organ microvascular and possibly macrovascular complications. *= P values < 0.05 Data presented with Standard deviations when available
= P values of 0.07 show clinical trend though not statistically significant. Also Patients on metformin alone
or in combination showed significant weight reduction; Weight 112 24.6 vs 92 18.5kg; BMI 41.8 12.2 vs
The classification of diabetes types is ongoing considerable evolution in the 2

last few years with recognition of several variants and subtypes that share Results; 34.7 8.6 kg/m .

features of traditional type 1 and type 2 diabetes. Examples include LADA,

Flatbush diabetes, Malnutrition related and Ketosis prone diabetes variants.

The medical literature has virtually no mention of any utility of oral

Summary and Conclusions;
hypoglycemic agents in the glycemic management of type 1 diabetes. We The classification of diabetes types and therefore the consequent established norms of
present our clinical experience of the use of selected oral agents in some treatment methods for diabetes types are not as absolute as previously thought.
patients with type 1 diabetes that suggest that further study in this area is Variants of diabetes that share features of several classic diabetes types are now
warranted. widely recognized. This evolution in diabetes classification may have significant
implications for established dogma in diabetes therapeutics.

Methods; Some OHAs may have a therapeutic adjunctive role in the management of type 1
diabetes.

Especially among heavier subjects with significant associated insulin resistance

there may be a place for adjunctive metformin use in some type 1 diabetics.
The Demographic information of all the type 1 diabetic Adjunctive OHAs in type 1 diabetics may improve glycemic control while reducing
patients managed in the outpatient private clinical overall insulin requirements.
practice of the Endocrinology Division of the University of In some settings adjunctive OHA use in type 1 diabetics could result in reduced
Mississippi Medical Center between July 2007 and July frequency and severity of hypoglycemia.
2010 was obtained through the medical records The potential role of selected OHAs in type 1 diabetes management is a worthwhile
Department. subject for further systematic study.

The Endocrinology and Diabetes clinical records for Bibliography and References;
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The data analysis was performed using Microsoft Excel

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