In the Japanese population, type 1 diabetes (T1D) exhibits heterogeneity in clinical form: the abrupt onset form and slowly progressive form. Patients with the slowly progressive form of T1D can be managed with a low dose of insulin within one year of diagnosis; nevertheless, insulin supplementation is necessary from diagnosis to maintain optimal glycemic control in pediatric cases. On the other hand, incretin-based therapies might be an option even for T1D patients in whom β-cell function is preserved at the early stage of diabetes. We administered incretin-based therapies to 4 children with slowly progressive T1D as initial treatment and investigated their clinical course. Slowly progressive T1D was detected in 4 children (9-15 years) with mild metabolic decomposition via urine glucose screening at schools. All children showed positivity for β-cell autoantibodies. These children showed preserved endogenous insulin secretion with glucagon-stimulated C-peptide levels of 1.54-2.67 ng/mL. As initial treatment, they received incretin-based therapies: 3 children were treated with glucagon-like peptide-1 receptor agonists and 1 was treated with a dipeptidyl peptidase 4 inhibitor. They sustained postprandial C-peptide levels of 2.29-6.60 ng/mL and maintained hemoglobin A1c levels of 5.6%-6.6% for 8-18 months following diagnosis, without insulin treatment. No problematic adverse events, including hypoglycemia, were observed with administration of the incretin-based therapies. These findings suggest that incretin-based therapies could be effective for safe maintenance of optimal glycemic control and preservation of β-cell function at an early diabetic stage in children with slowly progressive T1D. However, it is necessary to confirm the efficacy and safety of incretin-based therapies in a large number of patients.


T. Urakami: None. M. Aoki: None. Y. Abe: None.

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