Abstract
Glucagon-like peptide-1(GLP-1) agonists are widely used for treatment of type 2 diabetes(T2D). To date a number of reports have described improvements in glucose control with the addition of a GLP-1 agonist to the insulin regime in treatment of type 1 diabetes(T1D). From a physiological perspective there is credence to the notion that a GLP-1 agonist will lower glucose levels in people with T1D as they do in T2D. GLP-1 is an endogenous hormone that regulates secretion of both insulin and glucagon in response to meals. GLP-1 agonists also slow gastric emptying through effects on the autonomic nervous system/act centrally to increase satiety. Liraglutide is the most widely studied GLP-1 agonist in adults with T1D, as add-on therapy to insulin.ReportOur patient has experienced challenges with their T1D management for a number of years in spite of being maintained on a basal bolus regime and recently developed a foot ulcer (now healed). He works long hours in his own business. With the addition of Liraglutide to the basal bolus regime, by 8 weeks there was a frameshift in glucose profile as evidenced by FreeStyle® glucose monitoring. Time in range glucose (3.9-10.0mmol/l) increased from 43% to 80% with the percentage in the range >10.0mmol/l decreasing from 35% to 15%. Also variability decreased from 42.3% to 32.4%% and estimated HbA1c from 72mmol/mol to 52mmol/mol. The change in glucose levels was associated with a self-reported enhancement of sense of control of the T1DM day to day. In his own words ‘I feel in control of my diabetes for the first time in 20 years’.