By Dr. Steven Long, DO, MHA, CPT
Beyond Health | Precision Medicine for High-Performance Living
Type 1 diabetes (T1D) is classically defined by autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency. The standard of care—multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII)—remains essential for survival.
But survival isn’t the same as optimal healthspan. And while insulin therapy is the cornerstone of management, there’s growing evidence that adjunctive therapies may help address insulin resistance, improve glycemic variability, reduce complications, and enhance quality of life. At Beyond Health, we view T1D management as more than a basal-bolus algorithm. We integrate physiology, technology, lifestyle, and emerging pharmacologic tools to support patients in achieving the best outcomes possible.
Even with perfect adherence, insulin therapy is not a complete physiologic replacement for endogenous insulin production. Patients often face:
These challenges have led researchers to explore adjunct medications that target mechanisms beyond glucose replacement.
Rationale: Improves insulin sensitivity by decreasing hepatic gluconeogenesis and improving peripheral glucose uptake.
Evidence: Multiple trials, including the REMOVAL trial, found modest reductions in insulin dose, LDL cholesterol, and weight, but no significant long-term A1C improvement in well-controlled T1D (Petrie et al., 2017).
Clinical role: Considered in overweight/insulin-resistant T1D (“double diabetes”), with careful monitoring for GI side effects and B12 status.
Rationale: PPAR-γ agonist that increases insulin sensitivity in muscle and adipose tissue.
Evidence: Small trials show reduced insulin requirements and improved sensitivity, though weight gain and edema are potential adverse effects (Vella et al., 2003; Buzzetti et al., 2005).
Clinical role: Not routinely recommended but may be considered in selected insulin-resistant T1D patients, weighing benefits vs. risks.
Rationale: Promote urinary glucose excretion, leading to lower glucose, modest weight loss, and improved time-in-range.
Evidence: Trials show reductions in A1C (~0.3–0.4%), lower insulin dose, and weight loss. Risk of euglycemic DKA is significant (Danne et al., 2018).
Clinical role: May be considered in highly adherent adults with excellent DKA education, ketone monitoring, and close follow-up. Not FDA-approved for T1D in the U.S. due to DKA risk.
Rationale: Enhance satiety, slow gastric emptying, and reduce glucagon secretion—helpful in overweight T1D with insulin resistance.
Evidence: Trials show modest reductions in weight, insulin dose, and sometimes postprandial glucose; A1C benefit is less robust (Kuhadiya et al., 2016).
Clinical role: Off-label option in overweight/obese T1D for weight management and possibly improved glycemic stability, with careful monitoring for hypoglycemia.
Rationale: Amylin is co-secreted with insulin and is deficient in T1D. It slows gastric emptying, suppresses glucagon, and increases satiety.
Evidence: FDA-approved for T1D. Reduces postprandial glucose excursions and modestly lowers A1C (~0.3–0.5%), but requires additional injections and careful insulin dose reduction to avoid hypoglycemia (Ratner et al., 2004).
Clinical role: Useful in motivated patients struggling with postprandial spikes despite optimal insulin therapy.
Rationale: Target autoimmune destruction of beta cells.
Evidence: Approved for delaying onset in high-risk individuals (Stage 2), not for established disease (Herold et al., 2019).
Clinical role: Emerging role in prevention; currently no established benefit in long-standing T1D.
Pharmacologic therapy is only one layer. At Beyond Health, we also integrate:
Exercise is particularly important: resistance training improves insulin sensitivity, while Zone 2 training supports mitochondrial function and cardiovascular risk reduction—both critical in T1D patients.
This is why adjuncts are best reserved for motivated, well-educated patients with close clinical follow-up.
At Beyond Health, we don’t see Type 1 diabetes as a static diagnosis—we see it as a dynamic physiology to be supported, optimized, and protected. Insulin is essential. But for the right patients, the thoughtful addition of adjunct therapies—combined with nutrition, exercise, and technology—can improve glucose stability, reduce complications, and support long-term healthspan. The key is individualization. We do not chase novelty; we chase what works for you.
