Are patients with type 1 diabetes being treated with oral hypoglycemic agents to improve their response to injected insulin?

Yes. We have been using metformin from time to time in the clinic. Also see Gomez R, Mokhashi MH, Rao J, Vargas A, Compton T, McCarter R, Chalew SA. Metformin adjunctive therapy with insulin improves glycemic control in patients with type 1 diabetes mellitus: a pilot study, J Pediatr Endocrinol Metab 2002 Sep-Oct;15(8):1147-51.

DOB
Additional comments from Dr. Tessa Lebinger:

It has been known for years that patients with classical type 1 diabetes have inappropriately increased release of glucose from the liver and other issues of insulin resistance. See Jerry R. Greenfield, Katherine Samaras and Donald J. Chisholm Insulin Resistance, Intra-Abdominal Fat, Cardiovascular Risk Factors, and Androgens in Healthy Young Women with Type 1 Diabetes Mellitus, The Journal of Clinical Endocrinology & Metabolism Vol. 87, No. 3 1036-1040, for details. Recently there was an article describing improvement in control in adolescents with type 1 diabetes with the use of metformin, an oral agent which improves sensitivity to insulin and decreases production of glucose from the liver.

Theoretically if individuals with type 1 diabetes respond to metformin or other medications that improve the action of insulin, they might be able to get better control with less insulin and be less apt to gain weight which often happens with intensive therapy. There is also the risk, however, if individuals with type 1 diabetes develop ketones, they may be more apt to develop a complication called lactic acidosis if they are on metformin. Hopefully more studies will be done to more confirm this preliminary report and further identify for which individuals with type 1 diabetes these medications might be indicated or contraindicated.

TGL
Additional comments from Dr. Larry Deeb:

I would answer no, but would ask the following questions. Do you have an adolescent with a family history of type 2? Overweight? Maybe acanthosis nigricans? Even though you’ve clearly shown type 1 with diagnosis, size, antibodies, etc. over time they seem to grow into type 2-like too. Then I have used sensitizers, mostly metformin.

I also wonder about the potential for coexisting type 1 and type 2.

LD
Additional comments from Dr. Stuart Brink:

Rarely type 1 patients who are extremely obese will also receive metformin, or occasionally one of the thiazolidinediones medications. We have some general concerns about liver function in children and teenagers so do not usually use the glitazone class of medications since we do not have years of experience on safety. However, metformin has been used for many years and has a very good safety profile. There are several new studies, one from the University of Toronto recently presented at the September 2002 ISPAD meetings in Austria, that documents the benefits of metformin to help with the insulin resistance of puberty in type 1 patients. But, this is not yet standard treatment even though the research looks promising.

SB