From the Guidelines
GLP-1 receptor agonists can be used in type 1 diabetes as an adjunct therapy alongside insulin, with benefits including modest A1C reductions, weight loss, and reduced insulin doses, as evidenced by the most recent study from 2023 1.
Key Points to Consider
- The use of GLP-1 receptor agonists in type 1 diabetes is off-label, as they are not FDA-approved specifically for this condition.
- Liraglutide, at a dose of 1.8 mg daily, has been shown to reduce A1C levels by approximately 0.4%, decrease weight by about 5 kg, and lower insulin doses 1.
- Patients with type 1 diabetes should continue insulin therapy while using GLP-1 agonists, with potential adjustments to insulin doses to prevent hypoglycemia.
- The primary benefits of GLP-1 agonists in type 1 diabetes come from mechanisms other than stimulating insulin production, such as slowing gastric emptying, suppressing glucagon secretion, and reducing appetite.
Clinical Application
When considering the use of GLP-1 receptor agonists in type 1 diabetes, it is crucial to weigh the potential benefits against the risks, including the increased risk of diabetic ketoacidosis associated with certain adjunctive therapies 1. The most recent guidelines and consensus statements should guide patient selection and precautions 1.
Mechanism and Benefits
GLP-1 receptor agonists work through several mechanisms that can benefit patients with type 1 diabetes, despite their primary indication being for type 2 diabetes. These mechanisms include enhancing glucose-dependent insulin secretion (though this is less relevant in type 1 diabetes due to the minimal functioning beta cells), slowing gastric emptying, suppressing glucagon secretion, and reducing appetite 1. The reduction in insulin requirements and improvement in glycemic control, along with potential weight management benefits, make GLP-1 agonists a valuable adjunct therapy for selected patients with type 1 diabetes.
From the FDA Drug Label
Not indicated for use in type 1 diabetes mellitus Not for treatment of type 1 diabetes mellitus
GLP-1 receptor agonists should not be used in type 1 diabetes, as stated in the drug labels for semaglutide 2 and liraglutide 3.
From the Research
GLP-1 Receptor Agonists in Type 1 Diabetes
- GLP-1 receptor agonists are not currently approved for the treatment of type 1 diabetes, but they may have beneficial effects as an adjunctive therapy to insulin 4.
- These effects include improving glycemic control, reducing body weight, and decreasing insulin requirements 4, 5.
- GLP-1 receptor agonists have been shown to suppress inappropriate glucagon secretion, addressing alpha cell dysfunction in type 1 diabetes 5.
- Studies have demonstrated that GLP-1 receptor agonists, such as exenatide and liraglutide, can lead to weight loss, decreased total daily insulin requirements, and modest improvements in glycemic control in patients with type 1 diabetes 5.
Potential Benefits and Risks
- The use of GLP-1 receptor agonists in type 1 diabetes may be associated with a low risk of hypoglycemia 5.
- Patients with detectable C-peptide and/or those who are overweight or cannot achieve glycemic goals without hypoglycemia may benefit the most from GLP-1 receptor agonist therapy 5.
- Further studies are needed to evaluate the potential impact of GLP-1 receptor agonists on clinical outcomes such as microvascular and macrovascular complications in type 1 diabetes 4, 5.
Current Research and Future Directions
- Randomized, long-term, placebo-controlled clinical trials are warranted to fully assess the efficacy and safety of GLP-1 receptor agonists in type 1 diabetes 4.
- Research is ongoing to explore the potential of GLP-1 receptor agonists in type 1 diabetes, including their effects on beta-cell mass and function 6.
- The development of new GLP-1 receptor agonists with improved pharmacokinetic profiles and potential additional benefits, such as cardiovascular protection, may also be relevant to the treatment of type 1 diabetes 7, 8.