Improving beta‐cell secretory function and glycaemia in young‐onset type 2 diabetes: A pilot, 12‐month, randomized trial of a novel, continuous glucose monitor‐guided, rapid treatment intensification strategy incorporating empagliflozin and liraglutide

• Published in: Diabetes, obesity & metabolism obesity & metabolism, 2022-04, Vol.24 (4), p.747-751
• Main Authors: Middleton, Timothy L., Constantino, Maria I., McGill, Margaret, D’Souza, Mario, Yue, Dennis K., Twigg, Stephen M., Wu, Ted, Wong, Jencia
• Format: Article
• Language: English
• Subjects: Age groups; Antidiabetics; Benzhydryl Compounds; Blood Glucose; CGM; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - drug therapy; Disease management; GLP-1 receptor agonists; Glucose; Glucose monitoring; Glucosides - therapeutic use; glycaemic control; Humans; Hypoglycemic Agents - therapeutic use; Inhibitor drugs; Liraglutide - therapeutic use; Sodium-glucose cotransporter; Young adults; young‐onset type 2 diabetes; β‐cell function
• ISSN: 1462-8902; 1463-1326
• DOI: 10.1111/dom.14621

Young-onset type 2 diabetes (YT2D) is characterized by poorer glycaemic control, a higher complications burden and premature mortality when compared with older-onset T2D.1-3 It is now recognized that the more rapid and progressive decline in β-cell function seen in YT2D contributes to this higher-risk clinical picture.4 Preservation of β-cell secretory function early in the disease course is now a central focus of research to improve outcomes in YT2D. Although early improvement of glucotoxicity has long been postulated to have beneficial effects on the β-cell,5 the promise of first-line insulin treatment has not been shown to be of benefit in YT2D.4 Interestingly, there is an increasing body of evidence suggesting that glucagon-like peptide-1 receptor agonist and sodium-glucose cotransporter 2 inhibitors may protect or even augment β-cell function.6-8 In addition, the clinical efficacy of early combination therapy in YT2D with respect to the improvement in durability of glycaemic control is increasingly being recognized.9, 10 Here we report key feasibility, glycaemic and β-cell secretory outcomes of a 12-month pilot study exploring a novel, continuous glucose monitor (CGM)-guided, rapid treatment intensification (RTI) strategy to achieve early stringent glycaemic control, with the stepped use of empagliflozin and add-on liraglutide in young adults with recently diagnosed T2D.