Semaglutide Offers 'Reprieve' in Adults With Type 1 Diabetes

This transcript has been edited for clarity.

There was a recent letter in The New England Journal of Medicine about the effectiveness of semaglutide in adults with new-onset type 1 diabetes. The authors were from the State University of New York at Buffalo.

First, I can tell you that I love this report because it validates exactly what I do, which is to start patients with new-onset type 1 diabetes on a combination of insulin and low-dose semaglutide. This helps to reduce insulin requirements and simplify diabetes management.

This study was a retrospective analysis of 10 adult patients aged 21-39 who were within 3 months of their diagnosis of type 1 diabetes. All had positive antibodies and had an average A1c of 11.7%. All were on multiple daily insulin injections. Semaglutide was started at a very low dose of 0.125 mg daily and uptitrated with a reduction in prandial insulin doses. They only went up to a maximum of 0.5 mg semaglutide weekly.

At 3 months, basically everybody was off their prandial insulin, and at 10 months, seven of them were also off their basal insulin. A1c levels fell to 5.7% at 12 months and the C-peptide level basically doubled.

They compared their results to a control group, which consisted of four studies in which people with type 1 diabetes were followed early on their insulin therapy. In those studies, they saw that people did well for the first 6 months or so, but then their A1cs went up, signifying the end of what we historically call the honeymoon period. I see this very same thing in my patients.

You may ask, "Why do this? I'm not really modifying the disease." Most of these patients, over time, will need insulin again and act more like typical people with type 1 diabetes. This basically gives the patients something of a reprieve; perhaps you can call it a prolonged honeymoon phase. You basically reduce or eliminate the need for prandial insulin and you may reduce the need for basal insulin. For a year or two, these people have pretty easy-to-control diabetes.

I'm always very careful because I don't want people to think that they don't have diabetes or that they don't have to check their blood sugar because I want to know if glucose levels are starting to rise. I warn them that at times of stress or increased insulin resistance, such as illness or use of steroids, their glucose levels may go high again.

I make sure they come back for routine follow-up because I know that most of these patients, over time — and it may be a number of years; I can't always predict — will probably need the reinstitution of their insulin therapy.

It's an interesting and easier way to treat adult-onset type 1 diabetes. Thank you.

Anne L. Peters, MD, is a professor of medicine at the University of Southern California (USC) Keck School of Medicine and director of the USC clinical diabetes programs. She has published more than 200 articles, reviews, and abstracts, and three books, on diabetes, and has been an investigator for more than 40 research studies. She has spoken internationally at over 400 programs and serves on many committees of several professional organizations.

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Cite this: Semaglutide Offers 'Reprieve' in Adults With Type 1 Diabetes - Medscape - Sep 13, 2023.

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