Semaglutide effective for weight loss and improving glycemic control in type 1 diabetes: Study

"We strongly recommended performing perspective, large-randomized clinical trials with newer GLP-1 analogs like tirzepatide and semaglutide for subjects with T1D associated with overweight/obesity," the researchers wrote.

More than two-thirds of type 1 diabetes are obese/overweight in Western Europe and the USA, leading to insulin resistance as in type 2 diabetes (T2D). GLP-1 analogs are safe and effective in patients with T2D, improving glycemic metrics and aiding in weight loss, in addition to their positive effects on diabetic kidney disease and cardiovascular disease. None of the currently available GLP-1 analogs are approved for T1D patients.

The US Food and Drug Administration (FDA) has approved a higher dose of the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide for people with a body mass index (BMI) greater than 27 kg/m2. Satish K. Garg, University of Colorado Denver, Aurora, Colorado, USA, and colleagues evaluated the real-world use of semaglutide in overweight or obese patients with type 1 diabetes.

For this purpose, the researchers conducted a retrospective chart review study of 50 overweight or obese patients with T1D who were initiated on semaglutide and followed for one year. The control group consisted of 50 computer-matched patients (for race, sex, BMI, weight, and diabetes duration) during a similar period and were not on any weight loss medications. The mean age and duration of diabetes were 42 and 27 years, respectively. 

The study led to the following findings: 

• The continuous glucose monitors (CGM), insulin pump use, baseline BMI, and body weight were also similar in the two groups.
• Baseline glycosylated hemoglobin (HbA1c) was insignificantly lower in the semaglutide group (7.6% vs. 8.2%, respectively).
• Total daily insulin dose (TDD) and insulin dose per kg body weight were higher in the semaglutide group at baseline, with no difference in basal or prandial insulin dose.
• There were significantly greater declines in mean BMI, HbA1c, body weight, CGM glucose SD, and coefficient of variation (CV), and an increase in CGM time in range (TIR) in the semaglutide group compared to the control group with no difference in insulin dose changes, time above range (TAR), or time below range (TBR).

In conclusion, the study found semaglutide to be safe and effective in significantly lowering body weight and BMI at 1 year in patients with T1D, and improved glycemic metrics including, CGM TIR, HbA1c, and glycemic variability, with no difference in insulin dose.

"There is a need for proper large and long-term randomized controlled trials with semaglutide or newer GLP-1 analogs (tirzepatide) to evaluate efficacy and safety of these drugs in overweight/obese patients with T1D similar to the studies conducted in patients with T2D," the researchers wrote.

Reference:

Satish K. Garg, Gurleen Kaur, Zehra Haider, Erika Rodriquez, Christie Beatson, and Janet Snell-Bergeon.. Efficacy of Semaglutide in Overweight and Obese Patients with Type 1 Diabetes.. Diabetes Technology & Therapeutics.Mar 2024.184-189.http://doi.org/10.1089/dia.2023.0490