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 suggest considering GLP-1 RA or GIP/GLP-1 RA in most individuals prior to insulin, but this is in the context of type 2 diabetes management 1.
- In the context of type 1 diabetes, GLP-1 agonists and DPP-4 inhibitors are being studied, but are not currently FDA-approved for use in this population 1.
Key Points
- GLP-1 receptor agonists may be considered in patients with type 1 diabetes who have not achieved blood glucose goals with insulin therapy alone.
- The use of GLP-1 receptor agonists in type 1 diabetes requires careful consideration of the potential benefits and risks, including increased adverse events.
- More research is needed to fully understand the role of GLP-1 receptor agonists in the management of type 1 diabetes.
From the Research
Use of GLP-1 in Type 1 Diabetes Mellitus
- GLP-1 receptor agonists (GLP-1RAs) have been considered as an adjunctive treatment for individuals with Type 1 Diabetes Mellitus (T1D) using an automated insulin delivery system 2.
- The use of GLP-1RAs in T1D has been explored due to their potential to improve glycemic control, reduce weight, and lower the risk of hypoglycemia 3.
- Studies have shown that GLP-1 agonists can provide effective adjunct therapy and improve glycemic and metabolic outcomes in adults with T1D using automated insulin delivery systems 2.
- The potential benefits of GLP-1RAs in T1D include improved β-cell function, reduced glucagon secretion, and enhanced glucose-dependent insulin secretion 4, 3.
Safety and Efficacy
- The safety and efficacy of GLP-1RAs in T1D have been evaluated in several studies, with results showing significant reductions in hemoglobin A1C, plasma glucose concentration, body weight, and insulin doses 3.
- Adverse effects of GLP-1RAs in T1D are mostly gastrointestinal in nature, but are generally mild and transient 3.
- The use of GLP-1RAs in T1D may be beneficial for patients who experience adverse effects from insulin, those who are not at their A1C goal due to hypoglycemia, and those who may benefit from weight loss 3.
Potential Applications
- GLP-1RAs may be used in children and adolescents with T1D, although large-scale clinical trials are still needed to establish their safety and efficacy in this population 5.
- The use of GLP-1RAs as an adjuvant therapy in islet cell transplantation has also been explored, with potential benefits including improved β-cell mass and reduced risk of hypoglycemia 6.
- Further research is needed to fully understand the potential benefits and risks of GLP-1RAs in T1D, including their effects on β-cell function, glucagon secretion, and glucose-dependent insulin secretion 2, 4, 3.