GLP-1s May Benefit T1D, Uptake Increased Significantly in Patients with Obesity

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Two posters presented at the American Diabetes Association 84th Scientific Sessions looked into the impact of glucagon-like peptide-1 receptor agonists in type 1 diabetes management.

The use of glucagon-like peptide-1 receptor agonists (GLP-1s) has increased significantly over the past several years. The number of patients taking semaglutide (Ozempic)—one of the most popular GLP-1s—was 40 times higher in 2022 compared to 2019.1 The class of drugs, which also includes liraglutide and dulaglutide, are approved to treat type 2 diabetes, as well as obesity or overweight.

GLP-1s May Benefit T1D, Uptake Increased Significantly in Patients with Obesity / K KStock - stock.adobe.com

GLP-1s May Benefit T1D, Uptake Increased Significantly in Patients with Obesity / K KStock - stock.adobe.com

However, research has also shown that off-label prescriptions of GLP-1s for type 1 diabetes can provide benefits to patients. Recent data published in The Journal of Clinical Endocrinology and Metabolism found patients with type 1 diabetes who took GLP-1s had significant reductions in weight, glycated hemoglobin A1C, and total daily dose of insulin.2

READ MORE: Examining the Role of Remote CGM in Diabetes Management

At the American Diabetes Association 84th Scientific Sessions, held June 21 to 24 in Orlando, Florida, 2 posters took a deeper look into GLP-1 use among patients with type 1 diabetes, examining the use of tirzepatide in patients with the disease and trends in both obesity and GLP-1 use in the patient population.

In the first poster, investigators conducted a retrospective chart review to assess the efficacy and safety of tirzepatide in managing type 1 diabetes.3 The study cohort included 15 patients with an average age of 48 years and an average diabetes duration of 34 years who used continuous glucose monitoring. Of the patients, 8 were on insulin pumps, 7 had multiple daily injections, and 6 had prior exposure to GLP1s.

Over a 12-month period, investigators found that patients who took tirzepatide had significantly decreased A1c levels at 6 months. However, the change in A1c was not sustained 1 year after treatment initiation. Additionally, compared to an average baseline BMI of 34.7, the average BMI was reduced to 31.7 at 6 months and 28.9 at 1 year. There were some adverse events reported among the patients; 1 patient experienced severe hypoglycemia and 3 patients experienced mild nausea and constipation.

“These findings, while preliminary, highlight the potential benefits of GLP1/GIP agonists in type 1 diabetes management, warranting further investigation despite the risk of hypoglycemia and other side effects,” the authors concluded.

In the second poster, investigators conducted a study to characterize trends in obesity and GLP-1 use among youth and adults with type 1 diabetes in the United States from 2008 to 2022.4 The study cohort included 159879 patients who were identified in electronic health data by using a validated algorithm. Trends in overweight and obesity, and GLP1 prescriptions were characterized by BMI categories from 2008-2010 to 2020-2022.

Investigators found that, from 2008-2010 to 2020-2022, obesity in young patients increased from 19% to 26%, and from 28% to 37% in adults. During the same time period, severe obesity in young patients increased from 4% to 11%. Additionally, GLP-1 uptake saw a significant increase over the last 15 years, particularly among patients with severe obesity. Among young patients with severe obesity, 18% used GLP-1s, and among adults, 34% used the medications.

“Obesity has reached epidemic levels in patients with type 1 diabetes,” the authors concluded. “The off-label prescription of GLP-1s significantly increased over time, especially in severe obesity. More data on GLP-1’s effects in the type 1 diabetes population is needed.”

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References
1. Watanabe JH, Kwon J, Nan B, et al. Trends in glucagon-like peptide 1 receptor agonist use, 2014 to 2022. J Am Pharm Assoc. (2003). 2024 Jan-Feb;64(1):133-138. doi: 10.1016/j.japh.2023.10.002. Epub 2023 Oct 10. PMID: 37821008.
2. Edwards K, Li X, Lingvay I. Clinical and Safety Outcomes With GLP-1 Receptor Agonists and SGLT2 Inhibitors in Type 1 Diabetes: A Real-World Study. J Clin Endocrinol Metab. 2023 Mar 10;108(4):920-930. doi: 10.1210/clinem/dgac618. PMID: 36268825.
3. Childs BP, Sebes J, Molt L, et al. Use of Tirzepatide in Type 1 Diabetes. Presented at: American Diabetes Association 84th Scientific Sessions; June 21-24, 2024; Orlando, FL. Abstract 761-P.
4. Xu Y, Fang M, Coresh J, et al. Trends in Obesity and GLP-1RA Use among Youth and Adults with Type 1 Diabetes in U.S. Health System—2008–2022. Presented at: American Diabetes Association 84th Scientific Sessions; June 21-24, 2024; Orlando, FL. Abstract 1438-P.
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