From the Guidelines
Yes, Glucagon-like peptide-1 (GLP-1) can be used in patients with Type 1 Diabetes Mellitus, although it is not currently FDA-approved for this indication.
Rationale
- The use of GLP-1 receptor agonists, such as liraglutide, has been studied in patients with type 1 diabetes and has shown benefit in improving hemoglobin A1c levels and reducing body weight 1.
- However, the use of GLP-1 receptor agonists in type 1 diabetes is also associated with increased adverse events, including hypoglycemia and hyperglycemia with ketosis 1.
- The 2023 standards of care in diabetes recommend considering GLP-1 RA or GIP/GLP-1 RA in most individuals prior to insulin if injectable therapy is needed to reduce A1C 1.
- Other studies have also investigated the use of GLP-1 receptor agonists and dipeptidyl peptidase 4 (DPP-4) inhibitors in patients with type 1 diabetes, although they are not currently FDA-approved for this indication 1.
Key Points
- GLP-1 receptor agonists, such as liraglutide, may be used off-label in patients with type 1 diabetes to improve glycemic control and reduce body weight.
- However, the use of GLP-1 receptor agonists in type 1 diabetes requires careful consideration of the potential risks and benefits, including the increased risk of hypoglycemia and hyperglycemia with ketosis.
- A patient-centered approach should be used when considering the use of GLP-1 receptor agonists in patients with type 1 diabetes, taking into account patient preferences, cost, and potential side effects.
From the Research
Use of GLP-1 in Type 1 Diabetes Mellitus
- The use of Glucagon-like peptide-1 (GLP-1) receptor agonists as an adjunctive treatment for individuals with Type 1 Diabetes Mellitus (T1DM) has been explored in several studies 2, 3, 4, 5, 6.
- These studies suggest that GLP-1 receptor agonists may have a potential role in improving glycemic control, reducing insulin doses, and promoting weight loss in patients with T1DM 4, 6.
- The mechanism of action of GLP-1 receptor agonists involves stimulating insulin production and secretion from the pancreatic β cells in a glucose-dependent manner, improving gastric emptying, and reducing postabsorptive glucagon secretion from pancreatic α cells 6.
- Some studies have reported that GLP-1 receptor agonists may reduce excessive postprandial glucagon secretion, allowing patients to reduce their total daily dose of exogenous insulin, and minimize the risk of hypoglycemia 3, 6.
Benefits and Risks
- The benefits of using GLP-1 receptor agonists in T1DM include improved glycemic control, weight loss, and reduced insulin doses 4, 6.
- The risks associated with GLP-1 receptor agonists in T1DM include gastrointestinal adverse effects, such as nausea and vomiting, and the potential for hypoglycemia unawareness and dysregulated glucagon response 3, 5.
- However, some studies have reported that the risk of hypoglycemia may be minimized with the use of GLP-1 receptor agonists, as they preserve glucagon counter-regulation to some degree via their glucose-dependent action 6.
Current Status and Future Directions
- The current status of GLP-1 receptor agonists in T1DM is that they are not approved by the US Food and Drug Administration for the treatment of T1DM, but they are being used off-label in some cases 2.
- Future directions for research include conducting randomized controlled trials to document the efficacy and safety of GLP-1 receptor agonists in T1DM, and exploring their potential role in preserving beta-cell mass and prolonging the remission period in patients with T1DM 2, 5.