Impact of semaglutide use on glycemic and metabolic profile in adults with type 1 diabetes having overweight or obesity: A systematic review and meta-analysis

Dec 16, 2025Medicine

Semaglutide’s effects on blood sugar and metabolism in overweight adults with type 1 diabetes

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Abstract

Data from 274 adults with type 1 diabetes and overweight or obesity show that semaglutide is associated with a 7.6% reduction in body weight after 12 months.

Semaglutide use is associated with a reduction in glycated hemoglobin levels at 3 months (-0.54%), 6 months (-0.55%), and 12 months (-0.6%).
Total daily insulin dose decreased at 3 months (-0.05 units/kg/d) and 6 months (-0.07 units/kg/d), but not at 12 months.
Improvements in glycemic variability were observed, including a 4.62% increase in time in range after 3 months and an 8.97% decrease in time above range.
Adverse events related to semaglutide were mostly gastrointestinal and reported as scarce.

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BACKGROUND: Semaglutide is not yet approved for type 1 diabetes (T1D), but increasing evidence indicates it could offer clinical benefits for T1D patients, particularly those with overweight or obesity. Currently, no systematic review or meta-analysis has assessed semaglutide's effectiveness in adults with T1D with overweight or obesity; this systematic review and meta-analysis aims to fill that knowledge gap.

METHODS: Electronic databases were searched for articles on semaglutide use in adults with T1D with overweight or obesity. Co-primary outcomes were the percent changes in body weight and glycated hemoglobin from baseline; secondary outcomes were changes in total daily dose of insulin, glycemic variability, and adverse events. Statistical analysis was performed with RStudio software (Posit Software, PBC, Boston ), and results are presented as mean differences (MDs) along with 95% confidence intervals.

RESULTS: Data from 8 studies involving adults with T1D having overweight/obesity (N = 274, with diabetes duration ranging from 19.7 to 33 years) were analyzed. All studies had a low risk of bias. Semaglutide use was associated with reductions in body weight from baseline at 3 months (MD -3.27% [-6.07 to -0.47]), 6 months (MD -6.53% [-8.44 to -4.63]), and 12 months (MD -7.6% [-8.16 to -7.04]). There was also a reduction in glycated hemoglobin from baseline at 3 months (MD -0.54% [-0.62 to -0.46]), 6 months (MD -0.55% [-0.71 to -0.40]), and 12 months (MD -0.6% [-0.72 to -0.48]). Three months (MD -0.05 units/kg/d [-0.06 to -0.03]) and 6 months (MD -0.07 units/kg/d [-0.13 to -0.01]) but not 12 months (MD -0.00 units/kg/d [-0.06 to 0.05]) of semaglutide therapy were associated with a reduction in total daily dose of insulin. Time in range (MD 4.62% [0.85 to 8.39]) and time above range (MD -8.97% [-16.41 to -1.53]) improved after 3 months of semaglutide use. Adverse event data were scarce and mostly gastrointestinal.

CONCLUSION: In adults with T1D having overweight or obesity, short-term semaglutide effectively promotes weight loss, improves glycemic control, and reduces insulin requirements. More long-term randomized controlled trials with a diverse group of participants are needed to incorporate semaglutide into the routine clinical management of these patients.

Key numbers

7.6%

Body Weight Reduction

Reduction in body weight after 12 months of treatment.

0.6%

Reduction

Decrease in after 12 months of therapy.

0.07

Insulin Dose Reduction

Decrease in at 6 months of use.

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Impact of semaglutide use on glycemic and metabolic profile in adults with type 1 diabetes having overweight or obesity: A systematic review and meta-analysis

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