Can type 1 diabetics take injectable weight loss medications, such as semaglutide (glucagon-like peptide-1 (GLP-1) receptor agonist) and liraglutide (GLP-1 receptor agonist)?

Injectable Weight Loss Medications for Type 1 Diabetics

Type 1 diabetics can use certain injectable weight loss medications, but pramlintide is currently the only FDA-approved adjunctive therapy specifically for type 1 diabetes. Other medications like GLP-1 receptor agonists (semaglutide, liraglutide) show promise but require careful consideration of risks and benefits.

Current Evidence on Injectable Options for Type 1 Diabetes

FDA-Approved Options

• Pramlintide: The only FDA-approved adjunctive therapy for type 1 diabetes for weight management
  • Provides modest A1C reductions (0.3-0.4%) and modest weight loss (1 kg) 1
  • Based on the naturally occurring β-cell peptide amylin

GLP-1 Receptor Agonists (Off-Label)

• Liraglutide:

  • Clinical trials show modest A1C reductions (0.4%), weight decreases (5 kg), and reductions in insulin doses 1
  • FDA label specifically states: "Not for treatment of type 1 diabetes mellitus" 2
  • Higher risk of nausea (OR 6.5) and ketosis (OR 1.8) compared to placebo 3

• Semaglutide:

  • Recent evidence (2025) from the ADJUST-T1D trial shows promising results 4
  • 36% of type 1 diabetics with obesity achieved the composite outcome of improved time in glucose range and ≥5% weight reduction vs. 0% with placebo
  • Weight reduction of 8.8 kg compared to placebo
  • No diabetic ketoacidosis was reported in the trial, but sample size was small (72 patients)

Important Considerations and Risks

Diabetic Ketoacidosis (DKA) Risk

• SGLT2 inhibitors have shown increased rates of DKA in type 1 diabetes 1
• GLP-1 RAs have a lower but still present risk of ketosis 3

Hypoglycemia Management

• When adding these medications to insulin therapy, insulin dose adjustments are typically required
• Liraglutide studies did not show significantly elevated odds of severe hypoglycemia (OR 0.67) or symptomatic hypoglycemia (OR 0.89) 3

Monitoring Requirements

• More frequent blood glucose monitoring is recommended when initiating these therapies
• Patients should be educated about the signs and symptoms of DKA
• Regular follow-up to assess efficacy and adjust insulin dosing

Practical Approach to Injectable Weight Loss Medications in Type 1 Diabetes

1. First-line option: Pramlintide (if weight loss is the goal)

   • Only FDA-approved adjunctive therapy for type 1 diabetes
   • Modest weight loss benefits but established safety profile

2. Consider GLP-1 RAs (off-label) if:

   • Patient has significant obesity (BMI ≥30)
   • Patient is using automated insulin delivery or has good glycemic control
   • Patient understands the off-label nature and potential risks
   • Close monitoring is available

3. Avoid in patients with:

   • History of DKA
   • Poor compliance with insulin therapy
   • Inability to monitor glucose regularly
   • Personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2 2

The most recent evidence from the ADJUST-T1D trial 4 suggests that semaglutide may be effective and relatively safe in carefully selected type 1 diabetics with obesity who use automated insulin delivery systems, but larger studies are needed before this becomes standard practice.