From the Guidelines
GLP-1 is not currently a standard treatment for Type 1 Diabetes Mellitus, but it is being studied as a potential adjunct therapy to insulin.
Key Points
- GLP-1 receptor agonists, such as liraglutide, have shown benefit in patients with type 1 diabetes by improving hemoglobin A1c levels and reducing body weight 1.
- However, the use of GLP-1 receptor agonists in type 1 diabetes is associated with increased adverse events, including hypoglycemia and hyperglycemia with ketosis 1.
- The study on liraglutide in type 1 diabetes showed that hemoglobin A1c levels improved by 0.34 to 0.54 percentage point from a mean baseline of 8.2% with once-daily injections of liraglutide (1.8,1.2, or 0.6 mg) added to insulin therapy 1.
- Body weight reduction was 2.2 to 4.9 kg greater with liraglutide than placebo, but hypoglycemia rates increased by 20% to 30% 1.
- Due to the potential risks and lack of standardization, GLP-1 receptor agonists should be used with caution in type 1 diabetes, and only under the guidance of a healthcare professional.
Important Considerations
- Patients with type 1 diabetes who are considering GLP-1 receptor agonists should be closely monitored for signs of hypoglycemia and hyperglycemia with ketosis.
- The use of GLP-1 receptor agonists in type 1 diabetes is still investigational and not currently approved by the U.S. Food and Drug Administration.
From the Research
GLP-1 Suitability for Type 1 Diabetes Mellitus
- GLP-1 receptor agonists have been studied as a potential adjunctive treatment for type 1 diabetes mellitus (T1DM) due to their ability to reduce hemoglobin A1c (A1C) levels, promote weight loss, and decrease insulin doses without increasing the risk of hypoglycemia 2, 3.
- The mechanism of action of GLP-1 receptor agonists in T1DM involves glucose-dependent insulin secretion, reduced glucagon secretion, increased satiety, and delayed gastric emptying, which can help improve glycemic control and reduce postprandial hyperglycemia 2, 4.
- Clinical trials have demonstrated the efficacy and safety of GLP-1 receptor agonists, such as exenatide and liraglutide, in patients with T1DM, with significant reductions in A1C levels, body weight, and insulin doses, and minimal increases in hypoglycemia risk 2, 3.
- Patients with T1DM who may benefit from GLP-1 receptor agonist therapy include those with detectable C-peptide, overweight or obese individuals, and those who cannot achieve glycemic goals without hypoglycemia 3, 5.
- The use of GLP-1 receptor agonists in T1DM may also have potential benefits in terms of improving glycemic and metabolic outcomes, without increasing the risk of severe hypoglycemia or diabetic ketoacidosis, particularly when used in conjunction with automated insulin delivery systems 5.
- However, further research is needed to fully understand the effects of GLP-1 receptor agonists on glucagon dysregulation and hypoglycemia unawareness in patients with T1DM, as well as the potential impact on microvascular and macrovascular complications 3, 6.