Skip to content
type1.science
Phase 2CompletedNCT04545151

Verapamil to preserve beta-cell function in newly diagnosed type 1 diabetes (Ver-A-T1D)

A European Phase 2 trial (Ver-A-T1D, NCT04545151) tested whether once-daily slow-release verapamil — a cheap, repurposed blood-pressure pill — could protect the body's own insulin-making cells in adults newly diagnosed with type 1 diabetes. It narrowly missed its main goal at 12 months in the primary (intention-to-treat) analysis (P=0.06) but showed a significant benefit among participants who took the drug as prescribed (per-protocol, P=0.034), keeping interest in verapamil alive as a low-cost option to combine with immune therapies.

Primary endpoints

  • Change in stimulated C-peptide area under the curve during a 2-hour mixed-meal tolerance test, from baseline to 12 months (verapamil vs placebo)

Results so far

In the main (intention-to-treat) analysis, the 12-month difference in stimulated C-peptide narrowly missed statistical significance (P=0.06), so the trial did not formally meet its primary endpoint. A per-protocol analysis (participants who took the drug as prescribed) was statistically significant (P=0.034), and the C-peptide decline in the placebo group was slower than expected, leaving the trial underpowered. HbA1c was better with verapamil in the first 6 months; overall glucose control and insulin needs were similar. Verapamil was generally well tolerated, with mild, reversible first-degree heart block (about 22%) and slow heart rate (about 16%).

The full picture

What is being tested, and why it matters

When type 1 diabetes is newly diagnosed, many people still have some working insulin-making (beta) cells. Protecting even a fraction of them can mean steadier glucose, less insulin, and fewer dangerous lows. Ver-A-T1D asked whether verapamil — a decades-old, low-cost blood-pressure pill — could slow the loss of those cells.1 In the lab, verapamil lowers a stress protein (TXNIP) inside beta cells, helping them survive.2 Crucially, it works without suppressing the immune system, unlike most other disease-slowing therapies.3

Who it is for

The trial enrolled adults aged 18 to under 45, within 6 weeks of starting insulin, who had at least one diabetes autoantibody and some remaining insulin production.1 It did not include children — earlier verapamil work in children (the US CLVer trial) was a separate study.4

How it was designed

Ver-A-T1D was a randomised, double-blind, placebo-controlled Phase 2 trial run across 21 sites in six European countries (Austria, Belgium, France, Germany, Italy, and the UK) within the INNODIA network, sponsored by the Medical University of Graz.15 136 adults were randomised about 2:1 to once-daily slow-release verapamil (titrated 120 mg up to 360 mg) or placebo, on top of standard insulin, for 12 months.15 The main goal was the change in stimulated C-peptide (a measure of the body's own insulin output) during a mixed-meal test at 12 months.6

Key results

In the main analysis of everyone randomised, the 12-month C-peptide difference narrowly missed statistical significance (P=0.06), so the trial did not formally hit its target.5 However, among people who actually took the drug as prescribed, the benefit was significant (per-protocol, P=0.034).5 One reason the headline result fell short: C-peptide in the placebo group declined more slowly than expected, leaving the study underpowered.5 HbA1c was modestly better with verapamil in the first 6 months; insulin doses and glucose control were otherwise similar.5 Side effects were mild and reversible — first-degree heart block in about 22% and slow heart rate in about 16%.5

What it means and what's next

Ver-A-T1D is a "near-miss" rather than a clear win, but its pattern — plus prior positive trials in adults2 and children4 — keeps verapamil in play. Investigators emphasise its appeal as a cheap, non-immunosuppressive drug to combine with immune-modulating therapies.3 Posted full results are pending peer review.

References

  1. Wych J, Brunner M, Stenson R, et al. Investigating the effect of verapamil on preservation of beta-cell function in adults with newly diagnosed type 1 diabetes mellitus (Ver-A-T1D): protocol for a randomised, double-blind, placebo-controlled, parallel-group, multicentre trial. BMJ Open (2024). https://doi.org/10.1136/bmjopen-2024-091597 ↩ ↩2 ↩3 ↩4

  2. Ovalle F, Grimes T, Xu G, et al. Verapamil and beta cell function in adults with recent-onset type 1 diabetes. Nature Medicine (2018). https://doi.org/10.1038/s41591-018-0089-4 ↩ ↩2

  3. European Association for the Study of Diabetes (EASD 2025), reported by Medical Xpress. Study reports potential effects of verapamil in slowing progression of type 1 diabetes (2025). https://medicalxpress.com/news/2025-09-potential-effects-verapamil-diabetes.html ↩ ↩2

  4. Forlenza GP, McVean J, Beck RW, et al. Effect of Verapamil on Pancreatic Beta Cell Function in Newly Diagnosed Pediatric Type 1 Diabetes: A Randomized Clinical Trial (CLVer). JAMA (2023). https://doi.org/10.1001/jama.2023.2064 ↩ ↩2

  5. European Association for the Study of Diabetes (EASD 2025), reported by Medical Xpress. Study reports potential effects of verapamil in slowing progression of type 1 diabetes (2025). https://medicalxpress.com/news/2025-09-potential-effects-verapamil-diabetes.html ↩ ↩2 ↩3 ↩4 ↩5 ↩6 ↩7

  6. ClinicalTrials.gov. Verapamil SR in Adults With Type 1 Diabetes (Ver-A-T1D), NCT04545151 (accessed 2026). https://clinicaltrials.gov/study/NCT04545151 ↩