From the Guidelines
GLP-1 receptor agonists can be used to treat obesity in people with type 1 diabetes, as they have shown effectiveness in weight loss and improving glycemic control, although they are not FDA-approved specifically for this purpose. The use of GLP-1 receptor agonists, such as liraglutide, in type 1 diabetes patients has been studied, and the results show that it can lead to significant weight loss and improvement in hemoglobin A1c levels 1. However, it is essential to monitor patients for potential adverse effects, such as hypoglycemia and diabetic ketoacidosis.
When using GLP-1 receptor agonists in type 1 diabetes patients, it is crucial to:
- Start with the lowest dose and gradually increase to minimize gastrointestinal side effects
- Reduce insulin doses by 10-20% initially to prevent hypoglycemia, with further adjustments based on blood glucose monitoring
- Monitor patients for diabetic ketoacidosis, as GLP-1 agonists can mask symptoms of excessive insulin reduction
- Use these medications as part of a comprehensive approach, including dietary changes and physical activity
The pathophysiology of obesity in type 1 diabetes is complex, and emerging evidence suggests that obesity contributes to insulin resistance, dyslipidemia, and cardiometabolic complications in type 1 diabetes 1. Therefore, it is essential to address obesity in type 1 diabetes patients to improve their overall health outcomes. GLP-1 receptor agonists can be a valuable tool in this effort, but their use should be carefully considered and monitored to minimize potential risks.
From the FDA Drug Label
Not indicated for use in type 1 diabetes mellitus or treatment of diabetic ketoacidosis (1) The FDA drug label does not answer the question of using GLP-1 receptor agonist to treat obesity in type 1 diabetes, as it only mentions that semaglutide is not indicated for use in type 1 diabetes mellitus. 2
From the Research
GLP-1 Receptor Agonists in Treating Obesity in Type 1 Diabetes
- The use of GLP-1 receptor agonists (GLP-1RAs) has been explored for treating obesity in patients with type 1 diabetes, with studies showing promising results 3.
- A retrospective chart review study found that semaglutide, a GLP-1RA, was effective in lowering body weight and BMI, and improving glycemic metrics in patients with type 1 diabetes who were overweight or obese 3.
- Another study discussed the efficacy of GLP-1RAs in treating type 2 diabetes, highlighting their ability to reduce body weight and improve glycemic control, with potential benefits for patients with type 1 diabetes as well 4.
- A narrative review examined the efficacy of GLP-1RAs approved for weight management in patients with and without diabetes, finding that semaglutide resulted in greater weight loss compared to liraglutide, with potential differences in efficacy between patients with and without diabetes 5.
Mechanisms and Benefits of GLP-1RAs
- GLP-1RAs have been shown to have several benefits, including reducing cardiovascular risk, improving glycemic control, and promoting weight loss 6, 4.
- The mechanisms of GLP-1RAs involve augmenting hyperglycemia-induced insulin secretion, suppressing glucagon secretion, decelerating gastric emptying, and reducing calorie intake and body weight 4.
- A comprehensive study mapping the effectiveness and risks of GLP-1RAs found associations with reduced risk of substance use and psychotic disorders, seizures, neurocognitive disorders, and cardiometabolic disorders, among others 7.
Potential Limitations and Future Directions
- While GLP-1RAs have shown promise in treating obesity in type 1 diabetes, further research is needed to fully understand their efficacy and safety in this population 3, 5.
- Emerging multimodal approaches combining peptides targeting receptors at different levels may be of additional benefit, particularly in patients with diabetes 5.
- Continued study of the benefits and risks of GLP-1RAs is necessary to inform clinical care and guide research agendas 7.