Can semaglutide help reduce the total daily insulin dose for adults with Type 1 diabetes?
Semaglutide is a GLP-1 receptor agonist approved for type 2 diabetes and weight management, but it is not yet approved for type 1 diabetes (T1D). However, several studies have examined its use as an add-on to insulin in adults with T1D who are overweight or have obesity. The evidence suggests that semaglutide can help lower the total daily insulin dose while also promoting weight loss and improving blood sugar control.
What the research says
A post-hoc analysis of the ADJUST-T1D trial, a randomized placebo-controlled study, found that adults with T1D and obesity who took semaglutide 1 mg weekly for 26 weeks experienced a significant 22.6% reduction in total daily insulin dose compared to placebo 7. This reduction was driven more by decreases in bolus (mealtime) insulin (30.5%) than basal (background) insulin (15.6%) 7. The study also showed that the effect on insulin dose was partly due to weight loss and partly a direct drug effect 7.
A systematic review and meta-analysis of 8 studies involving 274 adults with T1D and overweight or obesity confirmed that semaglutide use was associated with reductions in total daily insulin dose, along with significant weight loss and improvements in HbA1c 11. Real-world evidence from a 12-month study of 42 adults with T1D reported a mean weight loss of 13.3% and a reduction in HbA1c of 0.4%, with many patients able to lower their insulin doses 10. A retrospective study in youth (ages 10-20) with T1D also found that GLP-1 receptor agonists, including semaglutide, reduced total daily insulin dose by about 21% in pump users after 12 months 9.
It is important to note that semaglutide is not currently approved for use in type 1 diabetes, and these studies were conducted in research settings. Gastrointestinal side effects are common, and some people may not tolerate the medication 10. The decision to use semaglutide should be made with a healthcare provider who can weigh the potential benefits and risks.
What to ask your doctor
- Could semaglutide be an option for me to help reduce my insulin dose and manage my weight?
- What are the potential side effects of semaglutide, especially gastrointestinal issues, and how can they be managed?
- How would my insulin doses be adjusted if I started semaglutide, and how often would I need to monitor my blood sugar?
- Are there any specific risks for people with type 1 diabetes, such as diabetic ketoacidosis (DKA), that I should be aware of?
- Is semaglutide covered by my insurance for type 1 diabetes, or are there other GLP-1 receptor agonists that might be more accessible?
This question is drawn from common patient questions about Diabetes & Endocrinology and answered using cited medical research. We do not provide individualized advice.