Work

A Novel Paradigm for Adult‐Onset Type 1 Diabetes: Once‐Weekly Basal Insulin and SGLT‐2 Inhibition to Harness Residual β‐Cell Function

Year: 2026

Type: article

Abstract: 2 nmol/L) and some of them benefit from a protracted phase without the need for insulin. Here, we propose a hypothesis-generating therapeutic paradigm with once-weekly basal insulin combined with an SGLT2 inhibitor (SGLT2is) as initial therapy in T1D patients with preserved C-peptide. Once-weekly basal insulin, approved in Europe and now also in the US, confirm comparable HbA1c reductions to insulin degludec or glargine, albeit always alongside prandial insulin. SGLT2is, approved as adjuncts in T1D in select regions, can control prandial peaks without boluses. No trials have tested the combination of weekly insulin with SGLT2is in adult T1D patients. Nonetheless, the rationale is robust especially in adults with C-peptide > 0·2 nmol/L. In this respect, we urge proof-of-concept trials of 12-months randomised studies in adults ≥ 18 years, to evaluate this combination.

Source: Diabetes/Metabolism Research and Reviews

DOI: 10.1002/dmrr.70247

Authors: Paolo Pozzilli, Richard David Leslie

Institutions: Università Campus Bio-Medico, Queen Mary University of London, Blizard Institute

Language: English

Topic: Diabetes Management and Research

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $4,780