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

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.

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.”

Click here for more of our coverage from ADA 2024.

Don’t get left behind: Sign up today for our free Drug Topics newsletter and get the latest drug information, industry trends, and patient care tips delivered straight to your inbox.

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.