Adjunctive Treatment in Insulin Therapy in Autoimmune-Mediated Diabetes (Type 1 and Type LADA Diabetes)

Tightening of the diabetes control criteria in the last few years induces searches for adjunctive drugs to reinforce the basic treatment typical for the specific type of the disease. Disorders of glucose homeostasis may be the result of a deficiency of insulin resulting from the destruction of cells. Formerly it was thought that this is the only factor in the pathogenesis of autoimmune diabetes. Currently, it is already known that insulin resistance is also present in these forms of diabetes, as well as impaired secretion and the action of other hormones. This diversity of mechanisms leading to the manifestation of diabetes causes that in addition to the drugs considered to be basic for a specific type of diabetes, supplementary drugs are needed to improve metabolic disorders. Metformin is traditionally used among these medicines. Currently, however, more modern drug groups are being used more and more often. There are many indications that they have a beneficial effect not only as drugs that reduce insulin resistance, but also may play a role in immunization processes and promote the protective function of cells. Among these new drug groups, GLP-1R receptor agonists stimulate the growth and differentiation of cells, and also affect the process of differentiation of young pancreatic cells and can participate in the reproduction of -cells of the pancreas. Experimental studies also indicate that GLP-1 may be used in gene therapy of diabetes and in the culture of cells for their use in transplantation. Role dipeptidyl peptidase-4 (DPP-4) inhibitors in autoimmune diabetes require further research. In the group of patients with LADA-type diabetes improved glycemic control was observed. The beneficial effect of DPP-4 inhibitors in combination with vitamin D3 observed in new-onset type 1 diabetes and in LADA in preserving the residual function of cells.