Type 1 diabetes is a medical condition caused by the destruction of insulin-producing pancreatic beta cells due to autoimmune responses. The disease affects a significant number of people worldwide. Preserving even a small amount of residual beta cell function through stimulated C-peptide secretion is a desirable goal, as it is linked to a lower risk of diabetes-related complications and hypoglycemia.
Several approaches have been explored in the last 30 years to maintain C-peptide secretion after the diagnosis of type 1 diabetes. Some medications have demonstrated effectiveness in preserving C-peptide secretion in newly diagnosed patients, as evidenced by randomized clinical trials. However, despite the positive impact on beta cell function and insulin secretion, only one medication has received approval from the US Food and Drug Administration, and none have been widely implemented in clinical settings.
Although teplizumab has been approved for treating stage 2 type 1 diabetes (positive diabetes-related autoantibodies with evidence of dysglycemia), it is not yet approved for stage 3 type 1 diabetes (new-onset, clinically evident). The majority of disease modification strategies for type 1 diabetes have focused on targeting immune responses.
A study conducted by the University of Minnesota and published in JAMA suggests that verapamil, a drug commonly prescribed for high blood pressure and heart conditions, can have a positive impact on the pancreas of children who have been recently diagnosed with type 1 diabetes (T1D).
Results of the CLVer clinical trial showed that oral verapamil is taken once a day improved the pancreas’ insulin secretion by 30% over the first year following diagnosis of T1D when compared with a control group that received a placebo.
“The beneficial effect of verapamil observed in the trial is extremely exciting,” said Antoinette Moran, MD, the study’s principal investigator and professor at the University of Minnesota Medical School. “Although we don’t know whether the beneficial effect of verapamil on insulin secretion by the pancreas will be sustained once treatment was stopped at 12 months, we do know that better pancreas function in the first year is associated with better long-term outcomes in type 1 diabetes.”
The University of Minnesota was one of six pediatric diabetes centres in the US that participated in the study. The trial included 88 children 8 to 17 years old who started the trial within 31 days of their T1D diagnosis. Participants were monitored for known side effects of verapamil, including effects on the heart, blood pressure and liver function. The study found that verapamil was well tolerated and very few of these side effects occurred.
In addition to evaluating verapamil, the trial also assessed whether an intensive glucose management approach that included the use of an automated insulin delivery system to try to get glucose levels as close to normal as possible could have a beneficial effect on the pancreas’ insulin secretion. As reported in a companion paper in JAMA, much better glucose levels were achieved with this approach compared with standard care that included the use of continuous glucose monitoring; however, a benefit on the pancreas was not observed. Nevertheless, the glucose levels achieved could have long-term benefits in reducing complications of diabetes.
“The fact that verapamil is low cost and readily available, is taken orally once a day, and has a very favourable safety profile makes it a very appealing treatment for children and adults who are diagnosed to have type 1 diabetes,” said Dr Moran.
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