Can type 1 diabetics use Ozempic (semaglutide)?

Ozempic (Semaglutide) Is Not Approved for Type 1 Diabetes and Should Not Be Used in This Population

Ozempic (semaglutide) is not approved for use in type 1 diabetes and should not be used in this population due to safety concerns, particularly the increased risk of diabetic ketoacidosis (DKA). 1

FDA Approval Status and Contraindications

The FDA label for Ozempic clearly states its limitations of use:

• Ozempic is indicated only for adults with type 2 diabetes mellitus
• Ozempic is not a substitute for insulin
• Ozempic is not indicated for use in patients with type 1 diabetes mellitus 1
• Ozempic is not indicated for treatment of diabetic ketoacidosis, as it would not be effective in these settings 1

Evidence from Clinical Guidelines

The American Diabetes Association (ADA) Standards of Care (2025) acknowledges that while some non-insulin medications have been studied in type 1 diabetes, they are not FDA-approved for this indication:

1. GLP-1 Receptor Agonists in Type 1 Diabetes:

   • Clinical trials with liraglutide 1.8 mg daily showed only modest A1C reductions (0.4%) in type 1 diabetes 2
   • While retrospective case series suggest potential benefits of semaglutide for individuals with type 1 diabetes and obesity, prospective studies are still ongoing 2

2. Safety Concerns with SGLT2 Inhibitors:

   • SGLT2 inhibitors in type 1 diabetes were associated with an increased rate of DKA 2
   • The SGLT1/2 inhibitor sotagliflozin showed an eightfold increase in DKA compared with placebo in type 1 diabetes 2

Approved Adjunctive Therapies for Type 1 Diabetes

Currently, the only FDA-approved adjunctive therapy to insulin for type 1 diabetes is:

• Pramlintide: An injectable amylin analogue that delays gastric emptying, blunts pancreatic secretion of glucagon, and enhances satiety 2
  • When pramlintide is used, prandial insulin dosing should be reduced to minimize the risk for severe hypoglycemia 2

Emerging Research

While there is emerging interest in using GLP-1 receptor agonists in type 1 diabetes:

• A recent review (2025) indicates that semaglutide and tirzepatide are not currently approved for type 1 diabetes treatment 3
• The review acknowledges that these medications may serve as potential add-on treatments to insulin in patients with type 1 diabetes, particularly those with features of "double diabetes" (type 1 diabetes with insulin resistance and/or obesity) 3
• However, this remains investigational and not supported by robust clinical trials or regulatory approval

Potential Risks of Off-Label Use

Using Ozempic in type 1 diabetes carries several risks:

1. Diabetic Ketoacidosis: GLP-1 RAs may mask symptoms of hyperglycemia while not providing sufficient insulin, potentially leading to DKA
2. Hypoglycemia: When combined with insulin therapy, there's an increased risk of hypoglycemia
3. Gastrointestinal Side Effects: Nausea, vomiting, and diarrhea are common with semaglutide 4
4. Retinopathy Complications: Rapid improvement in glycemic control with semaglutide may worsen existing diabetic retinopathy 2

Conclusion

Based on the current FDA labeling and clinical guidelines, Ozempic (semaglutide) should not be used in patients with type 1 diabetes. The standard of care for type 1 diabetes remains insulin therapy, with pramlintide as the only approved adjunctive therapy. While research continues to explore potential benefits of GLP-1 RAs in specific type 1 diabetes populations, their use remains investigational and not supported by regulatory approval.