Is it safe to use Ozempic (semaglutide) in a patient with type 1 diabetes, insulin resistance, and a history of gastroparesis with normal emptying due to pyloroplasty?

From the Guidelines

Semaglutide (Ozempic) is not recommended for patients with Type 1 diabetes, particularly those with a history of gastroparesis, due to the potential risk of worsening delayed gastric emptying and complicating glucose management. The patient's history of gastroparesis, despite current normal emptying due to pyloroplasty, poses a significant concern when considering the use of semaglutide, as it may exacerbate gastrointestinal symptoms if the gastroparesis recurs 1. Additionally, semaglutide is not FDA-approved for Type 1 diabetes and may complicate glucose management in a patient already dependent on exogenous insulin, requiring careful dose adjustments of both medications if used together 1. For addressing insulin resistance in Type 1 diabetes, metformin might be considered as an adjunct therapy under close supervision, starting at 500mg daily and potentially increasing to 1000mg twice daily as tolerated 1. The most recent guidelines suggest that GLP-1 receptor agonists, such as semaglutide, may have adverse effects on gastrointestinal motility, and their use should be balanced against their potential benefits 1. Therefore, the primary focus for managing Type 1 diabetes should be on optimizing insulin therapy and monitoring blood glucose levels closely, rather than introducing medications like semaglutide that could potentially introduce more risks than benefits in this specific patient population. Key considerations include:

• The potential for semaglutide to worsen gastroparesis symptoms
• The lack of FDA approval for semaglutide in Type 1 diabetes
• The need for careful dose adjustments when using semaglutide with insulin therapy
• The potential benefits and risks of using metformin as an adjunct therapy for insulin resistance in Type 1 diabetes.

From the FDA Drug Label

• OZEMPIC is not a substitute for insulin. OZEMPIC is not indicated for use in patients with type 1 diabetes mellitusor for the treatment of patients with diabetic ketoacidosis, as it would not be effective in these settings. The FDA drug label does not answer the question regarding the safety of using Ozempic in a patient with type 1 diabetes, insulin resistance, and a history of gastroparesis with normal emptying due to pyloroplasty, but it does state that Ozempic is not indicated for use in patients with type 1 diabetes mellitus 2.

From the Research

Safety of Ozempic in Type 1 Diabetes with Gastroparesis and Normal Emptying due to Pyloroplasty

• The use of Ozempic (semaglutide) in patients with type 1 diabetes, insulin resistance, and a history of gastroparesis with normal emptying due to pyloroplasty has not been directly studied in the provided evidence.
• However, the studies suggest that pyloroplasty can improve gastric emptying and symptoms in patients with gastroparesis 3, 4, 5.
• Gastroparesis is a condition characterized by delayed gastric emptying, and symptoms include nausea, vomiting, abdominal fullness, and early satiety 6, 7.
• The management of gastroparesis includes assessment and correction of nutritional state, relief of symptoms, improvement of gastric emptying, and glycemic control in diabetics 6.
• Prokinetic agents, such as metoclopramide and domperidone, and mechanical therapies, such as gastric electrical stimulation and gastrostomy or jejunostomy, are used to treat gastroparesis 6, 7.
• Ozempic (semaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist, which may affect gastric emptying and motility, but its safety and efficacy in patients with type 1 diabetes and gastroparesis with normal emptying due to pyloroplasty are unknown based on the provided evidence.

Considerations for Ozempic Use

• The studies provided do not directly address the safety and efficacy of Ozempic in patients with type 1 diabetes, insulin resistance, and a history of gastroparesis with normal emptying due to pyloroplasty.
• However, the evidence suggests that pyloroplasty can improve gastric emptying and symptoms in patients with gastroparesis, which may be beneficial for patients with type 1 diabetes and insulin resistance 3, 4, 5.
• The use of Ozempic in these patients should be carefully considered, taking into account the potential benefits and risks, and closely monitoring for any adverse effects on gastric emptying and glycemic control.