Une place pour des traitements antidiabétiques en plus de l'insuline chez les jeunes diabétiques de type 1 ?

Many adolescents and young people with type 1 diabetes (T1D) have a poor glycemic control, above the targets for one or decades with the risk oflong-term consequences. This remains true despite the huge advances made since the discovery of insulin. In addition they are often exposed to high doses of insulin and weight gain, two factors limiting their glycemic control. Furthermore they are threatened by severe hypoglycemia and by ketoacidosis. Several studies conclude to an «atypical» insulin resistance present in these patients. The pathophysiology shows that even in well treated TD1 by sophisticated insulin, postprandial endogenous glucose production, and glucagon levels are higher compared to nondiabetics, and accompanied by an accelerated gastric emptying. Therefore the addition of complementary treatments represents a very active field of research. The addition of metformin may have some benefits but limited on HbA 1c; thiazolidinediones have mostly adverse effects (weight gain and fluid retention). To act on the above-described disorders, pramlintide, an amylin analog, and especially the GLP1 receptor agonists (GLP1 -a) are particularly well suited and the results recently published -and reported in this ADA 2015 scientific sessions- are very promising. GLP1-a have significant benefits on mean glycemic levels and variability, induce weight loss, and decrease insulin doses, opening a realistic therapeutic approach, with less constraints and side effects when compared to those of pramlintide. Cotransporters Na+/glucose type 2 inhibitors (SGLT2-i) or glifozines also show very positive results but their side effects recently reported, ketoacidosis, make them less attractive than GLP1-a. If these concerns are raised, a triple therapy insulin/GLP1-a/SGLT2-i should also be considered. The safety of these approaches is particularly necessary since these subjects are young and should receive these treatments foryears