Semaglutide Can Ease The Insulin Need in T1DM

A small case series suggests that using a GLP-1 receptor agonist, such as semaglutide, at an early stage of type 1 diabetes may reduce the reliance on insulin. In this study, ten adults recently diagnosed with type 1 diabetes initially received a weekly dose of 0.125 mg of semaglutide, which was adjusted up to a maximum of 0.5 mg per week as their prandial (mealtime) insulin doses were reduced.

Within just 3 months of starting semaglutide, all ten patients were able to completely discontinue their prandial insulin. Within 6 months, seven patients were also able to eliminate their basal (background) insulin. These findings were reported by Dr. Paresh Dandona and colleagues from the State University of New York at Buffalo in a New England Journal of Medicine correspondence.

The researchers noted that these initial observations support the need for larger, prospective, randomized clinical trials to further investigate this approach. It’s worth mentioning that while GLP-1 receptor agonists like semaglutide are commonly used for type 2 diabetes and obesity, none of them, nor SGLT2 inhibitors, are currently FDA-approved for type 1 diabetes. This is often due to concerns about the risk of diabetic ketoacidosis and hypoglycemia associated with their potent glucose-lowering effects.

The patients in this case series, aged 21 to 39, were followed from 2020 to 2022. Half were female, predominantly white, with an average baseline BMI of 25.1. Most presented with diabetic ketoacidosis or classic diabetes symptoms like excessive thirst, urination, and weight loss. Nine of the patients had antibodies against glutamic acid decarboxylase, a marker of autoimmune diabetes, and one had autoantibodies against islet antigen 2.

Semaglutide treatment began within 3 months of diagnosis, as many new-onset type 1 diabetes patients still have functioning beta cells. While adjusting medication doses, carbohydrate intake was restricted for all patients.

HbA1c levels decreased significantly, from an average of 11.7% at baseline to 5.9% at the 6-month mark on semaglutide. This continued to drop slightly to 5.7% at 12 months. Patients on semaglutide also experienced a notable increase in fasting C-peptide levels, indicating improved insulin production, and spent the majority of their time within the target glucose range as measured by continuous glucose monitoring.

The researchers acknowledged the absence of a control group but compared their HbA1c data with control groups from other studies involving early type 1 diabetes patients. These studies showed an initial improvement in HbA1c during the first 6 months, followed by an increase, consistent with the end of the “honeymoon period” in early type 1 diabetes treatment.

Mild hypoglycemia was observed during the semaglutide dose titration, but once the dose stabilized, no patients experienced hypoglycemic episodes or diabetic ketoacidosis. The baseline insulin doses were also recorded for reference.