“Semaglutide in Early Type 1 Diabetes”, Paresh Dandona, Ajay Chaudhuri, Husam Ghanim2023-09-07 ()⁠:

[appendix] Most patients with new-onset type 1 diabetes have substantial intact beta-cell reserve.1 Thus, we analyzed the efficacy of semaglutide, an agonist of glucagon-like peptide 1 (GLP-1), in patients with a new diagnosis of type 1 diabetes.

2020–22022 at our center, we included 10 patients between the ages of 21 and 39 years who had initiated semaglutide treatment within 3 months after a diagnosis of type 1 diabetes in a retrospective analysis of metabolic outcomes at 1 year.

…Semaglutide was started at a weekly dose of 0.125 mg to monitor side effects and avoid hypoglycemia. Subsequently, the dose of prandial insulin was adjusted down, whereas the semaglutide dose was adjusted up to a maximum of 0.5 mg weekly. The basal insulin dose was reduced according to data from continuous glucose monitoring. Carbohydrate intake was restricted in all the patients.

Prandial insulin was eliminated in all the patients within 3 months, and basal insulin was eliminated in 7 patients within 6 months. These doses were maintained until the end of the 12-month follow-up period. The mean glycated hemoglobin level fell to 5.9±0.3% at 6 months and to 5.7±0.4% at 12 months. The fasting C-peptide level increased in all the patients to a mean of 1.05±0.40 ng per milliliter, and the time-in-range was 89±3% according to continuous glucose monitoring. Mild hypoglycemia was recorded during the period in which the semaglutide dose was increased. After dose stabilization, no episodes of hypoglycemia were reported, along with no reports of diabetic ketoacidosis or other serious side effects.

Figure 1: Glycated Hemoglobin Levels in Patients with Recently Diagnosed Type 1 Diabetes. Shown are glycated hemoglobin levels after the initiation of semaglutide treatment in 10 adult patients who had recently received a diagnosis of type 1 diabetes at a single center, as compared with historical data from adult control groups in two trials with available point estimates and variability ranges from referenced articles. Patients in the control groups were receiving standard-of-care (SOC) therapy consisting of education regarding type 1 diabetes, insulin treatment with or without continuous glucose monitoring, and placebo. All the patients in the semaglutide group were receiving SOC with basal and prandial insulin therapy before starting semaglutide.
Figure 1: Glycated Hemoglobin Levels in Patients with Recently Diagnosed Type 1 Diabetes. Shown are glycated hemoglobin levels after the initiation of semaglutide treatment in 10 adult patients who had recently received a diagnosis of type 1 diabetes at a single center, as compared with historical data from adult control groups in two trials with available point estimates and variability ranges from referenced articles.3,4 Patients in the control groups were receiving standard-of-care (SOC) therapy consisting of education regarding type 1 diabetes, insulin treatment with or without continuous glucose monitoring, and placebo. All the patients in the semaglutide group were receiving SOC with basal and prandial insulin therapy before starting semaglutide.

…In this small case series, we found that the initiation of semaglutide soon after the diagnosis of type 1 diabetes was associated with the elimination of prandial insulin in all 10 patients and basal insulin in most of the patients, along with increased C-peptide levels and better glycemic control during the year of observation.

View PDF:

Semaglutide in Early Type 1 Diabetes