GLP-1 Receptor Agonists in Overweight and Obese Individuals With Type 1 Diabetes Using an Automated Insulin Delivery Device: A Real-World Study

Oct 17, 2024Journal of diabetes science and technology

GLP-1 Medicines and Their Use with Automated Insulin Delivery in Overweight People with Type 1 Diabetes: Real-World Results

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Abstract

Nineteen individuals with type 1 diabetes experienced a 11% reduction in body weight after six months of treatment with glucagon-like peptide-1 receptor agonists.

At the start of treatment, the median hemoglobin A1c level was 7.3%, indicating overall glycemic control.
Time in the target glucose range was 74%, with minimal time spent below range at 1%.
After six months, the total daily insulin dose decreased by 15.1 IU.
No significant changes were observed in hemoglobin A1c or other glucose measures after treatment.
One individual experienced ketoacidosis due to infusion set failure, but there were no reports of severe hypoglycemia.

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INTRODUCTION: Automated insulin delivery (AID) systems have improved glycemic control in individuals with type 1 diabetes (T1D) but overweight and increased cardiovascular risk remain a challenge. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with improved cardiometabolic profile but are currently not approved for the treatment of T1D.

MATERIAL AND METHODS: Individuals with T1D at Steno Diabetes Center Copenhagen, Denmark, treated with AID and off-label GLP-1 RA for at least six months between January 2017 and May 2024 were included in a retrospective chart review study.

RESULTS: Nineteen individuals with (median [range]) age 42 (24-60) years were included. At GLP-1 RA initiation, hemoglobin A1c (HbA1c) was 7.3% (6.1%-8.7%), HbA1c 56 (43-72) mmol/mol, body weight 91.5 (78.0-115.0) kg, and body mass index 35.4 (27.0-42.0) kg/m. Time in range was 74% (29%-82%), time above range 25% (18%-71%) while time below range was 1% (0%-5%). After six months of treatment, body weight changed -11% (-22% to -3%;= .001) and total daily insulin dose changed -15.1 (-32.5 to -8.2) IU (= .004). There were no significant changes in HbA1c or other glucose measures. One person developed ketoacidosis caused by infusion set failure, but none reported severe hypoglycemia. 2P P

CONCLUSION: Glucagon-like peptide-1 receptor agonist as add-on therapy for six months in individuals with obesity and AID-treated T1D led to considerable weight loss and a reduction in insulin dose.

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GLP-1 Receptor Agonists in Overweight and Obese Individuals With Type 1 Diabetes Using an Automated Insulin Delivery Device: A Real-World Study

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