Can Patients with Type 1 Diabetes Use Ozempic?

Can patients with Type 1 Diabetes use Ozempic? This question has two aspects:

• Ozempic for type 1 diabetes patients to control blood glucose, or
• Ozempic for type 1 diabetes patients to improve insulin resistance and lose weight

Not all patients with diabetes type 1 are thin and lean. Ozempic may result in weight loss in these patients and lower the risk of all the complications associated with obesity!

So, if we are talking about the role of Ozempic in type 1 diabetes patients for controlling hyperglycemia, the answer is “No“.

Ozempic for Type 1 Diabetes Patients to control blood glucose:

Patients with Type 1 diabetes mellitus are insulin-deficient. Ozempic (Semaglutide) lowers blood glucose by enhancing the release of insulin in a glucose-dependent mechanism.

Patients with type 1 diabetes are insulin deficient. There is absolute insulin deficiency. The Beta-cells are non-functional. Hence the beta-cells can not be stimulated to secrete insulin.

The only treatment for patients with Type 1 diabetes mellitus is insulin. Recently, an SGLT-2 inhibitor (Dapagliflozin) got approved by the EMA for the treatment of obese patients with diabetes mellitus type 1 who were not prone to ketosis. However, this indication has also been withdrawn.

This was also because physicians were not comfortable prescribing Dapagliflozin (Farxiga) because of the risks of Euglycemic Ketoacidosis.

To conclude, Ozempic can not lower blood glucose in type 1 diabetes patients.

Ozempic for Type 1 Diabetes patients for Weight loss and insulin resistance:

The weight loss mechanisms of Ozempic are slightly different than their glucose-lowering effects. Ozempic can be used theoretically for the treatment of obesity and insulin resistance in type 1 diabetes patients.

Insulin resistance is not very common in type 1 diabetes. However, a subgroup of patients with type 1 diabetes who are obese and require higher doses of insulin may have concomitant insulin resistance.

Recently, two large trials evaluated the role of metformin in type 1 diabetes patients with insulin resistance. It was concluded that metformin lowers insulin requirements, reduces body weight, and LDL cholesterol at the risk of more gastrointestinal side effects [Ref]

Another review article evaluated the role of GLP-1 agonists in obese type 1 diabetic patients. It was observed that all GLP-1 lowered HbA1C, however, compared to a placebo medicine, the effect was non-significant.

In contrast to the blood-glucose-lowering effects, the weight loss effects of GLP-1 agonists were significant compared to placebo medicine [Ref].

A maximum weight loss of 6.4 kg was observed over a period of 24 weeks. Liraglutide (Saxenda) was considered one of the best GLP-1 agonists that resulted in significant weight loss. However, in this review, studies on Ozempic use in obese T1 DM patients were not included.

This was probably because of a lack of data. Since Ozempic has proven to be superior to Liraglutide, it may be considered in obese patients with T1 DM who have suboptimal glucose control despite intensive insulin therapy.

In Conclusion:

Ozempic should not be used for hyperglycemia in patients with T1 DM, however, it can be considered a weight-loss medicine.

More clinical trials are needed to evaluate the effect of Ozempic (or Wegovy) in patients with type 1 diabetes patients.