From the Guidelines
GLP-1 receptor agonists (GLP-1RAs) may be considered as an adjunctive therapy in specific situations for Type 1 diabetes management, particularly for overweight or obese patients, as they have shown modest A1C reductions and weight loss benefits, as seen in studies with liraglutide 1.8 mg daily 1. When used, typical starting doses follow standard protocols, such as liraglutide starting at 0.6mg daily and titrating up weekly to 1.2-1.8mg. These medications work by enhancing glucose-dependent insulin secretion, suppressing glucagon release, slowing gastric emptying, and reducing appetite. However, they cannot replace insulin therapy in Type 1 diabetes since these patients have minimal or no endogenous insulin production. Some key points to consider when using GLP-1RAs in Type 1 diabetes include:
- Monitoring for potential side effects, including nausea, vomiting, and hypoglycemia, which may require insulin dose adjustments 1
- Maintaining insulin regimens as the primary treatment, with GLP-1RAs used as an adjunct to help with weight management and potentially reduce insulin requirements 1
- Considering the benefits and risks of GLP-1RAs in the context of individual patient needs and health status, as outlined in consensus reports such as the 2021 ADA/EASD consensus report on the management of type 1 diabetes in adults 1
From the FDA Drug Label
• Not indicated for use in type 1 diabetes mellitus or treatment of diabetic ketoacidosis (1).
GLP-1RAs are not used in Type 1 DM, as stated in the drug label for semaglutide (PO) 2 and 2. The label explicitly states that GLP-1RAs are not indicated for use in type 1 diabetes mellitus.
From the Research
Use of GLP-1RAs in Type 1 Diabetes Mellitus
- GLP-1RAs are commonly used in combination with insulin to manage type 2 diabetes mellitus, but research has also explored their potential in managing type 1 diabetes mellitus (T1DM) 3, 4, 5.
- Studies have shown that GLP-1RAs can be effective in reducing hemoglobin A1c (HbA1c) levels, body weight, and insulin doses in patients with T1DM, without increasing the risk of hypoglycemia 3, 4, 5.
- The mechanisms of action of GLP-1RAs, including augmentation of hyperglycemia-induced insulin secretion, suppression of glucagon secretion, and deceleration of gastric emptying, can be beneficial for patients with T1DM 3, 4, 5.
Efficacy and Safety of GLP-1RAs in T1DM
- A systematic review and meta-analysis found that combination therapy with insulin and GLP-1RAs led to greater reductions in HbA1c levels and weight, and reduced the daily weight-adjusted bolus insulin dose, compared to control treatments 4.
- Another study found that liraglutide, a GLP-1RA, had a significant effect on reducing HbA1c levels, body weight, and total daily insulin doses in patients with T1DM, with a low risk of hypoglycemia 5.
- Adverse effects of GLP-1RAs in T1DM patients were mostly gastrointestinal in nature, but were mild and transient 3, 4, 5.
Guidelines and Recommendations
- The use of GLP-1RAs in T1DM is not yet widely established, but some guidelines suggest that they may be considered as an adjunctive therapy for patients with T1DM who are not achieving glycemic goals with insulin therapy alone 6, 7.
- However, more research is needed to fully understand the efficacy and safety of GLP-1RAs in T1DM, and to establish clear guidelines for their use in this population 3, 4, 5.