New Treatment Approaches May Help Teens With Type 1 Diabetes Manage Complications

A new clinical trial led by researchers at The Hospital for Sick Children and the University of Toronto suggests that adding an investigational medication called dapagliflozin to standard insulin therapy may help teenagers with type 1 diabetes manage their condition more effectively.

The study included 98 patients between ages 12 and 18. Some received dapagliflozin alongside their regular insulin, while others received a placebo. The results showed that those on the combination therapy experienced improved blood sugar control, better kidney function, and less weight gain—side effects that commonly occur with insulin use alone.

Researcher Farid Mahmud noted that these findings could guide a new early intervention strategy, particularly for young people at risk of developing kidney complications from type 1 diabetes. However, this is early-stage research, and more study is needed before widespread use.

Protecting the kidneys is a major concern for people with type 1 diabetes, as the condition can lead to kidney disease over time. A phase 3 clinical trial published in The New England Journal of Medicine tested a medication called finerenone in adults with type 1 diabetes and existing kidney damage.

The study involved 242 adults already taking standard kidney-protective medications (ACE inhibitors or angiotensin-receptor blockers). Over six months, those taking finerenone showed a 34% reduction in a key marker of kidney damage, compared to just 12% reduction in those taking placebo. This 25% difference suggests finerenone may offer additional kidney protection when added to current treatments.

While these results are encouraging, finerenone is still being studied in type 1 diabetes. People with type 1 diabetes and concerns about kidney health should discuss these findings with their healthcare team.

Researchers are increasingly interested in using noninsulin medications alongside insulin therapy in type 1 diabetes. A comprehensive review of 51 clinical trials examined several different drug classes to see how well they work when added to insulin.

Two medication classes showed the most promise: GLP-1 receptor agonists (which can lower blood sugar by up to 0.7%, reduce insulin doses by up to 18.5%, and lower weight by up to 9.3 kg) and SGLT inhibitors (which lower blood sugar by up to 0.5%, reduce insulin doses by up to 15.3%, and lower weight by up to 4.3 kg). Neither class significantly increased the risk of severe low blood sugar.

However, SGLT inhibitors did carry a higher risk of a serious condition called diabetic ketoacidosis, so they require careful monitoring. Other medications tested—including metformin and certain other drugs—did not show sustained benefit for type 1 diabetes. These findings suggest that GLP-1 receptor agonists may be particularly valuable as add-on therapy, though more research is needed.

For people who struggle to manage type 1 diabetes with traditional insulin therapy, hybrid closed-loop systems offer another option. These systems combine a continuous glucose monitor with an insulin pump and automated software that adjusts insulin delivery throughout the day and night.

A systematic review of 12 randomized controlled trials comparing hybrid closed-loop systems to standard continuous glucose monitoring plus insulin pumps found that the automated systems improved blood sugar control. Specifically, hybrid closed-loop reduced HbA1c (a measure of average blood sugar over three months) by 0.28% more than standard pump therapy, and increased the time people spent in their target blood sugar range.

These technologies represent an ongoing evolution in diabetes management and may benefit people having difficulty with conventional approaches.

The research emerging from these studies points toward a future where type 1 diabetes treatment may be increasingly personalized, with doctors choosing to add specific medications based on an individual's needs—whether that's better blood sugar control, kidney protection, weight management, or reduced insulin doses.

For teenagers with type 1 diabetes, the combination therapy approach may open new options for preventing long-term complications like kidney disease. For adults, medications like finerenone and GLP-1 receptor agonists may provide additional tools for managing cardiovascular and metabolic risks.

It is important to remember that these are research findings at various stages of development. Anyone with type 1 diabetes considering new treatments should talk with their healthcare provider about whether these approaches might be appropriate for their individual situation.

Origin: University of Toronto (News report). Evidence: News report, corroborated with 3 indexed studies. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.