Dr. Ahmed Key Findings
- A significant decrease was observed in emergency department visits related to hyperglycemia in type 1 diabetes patients using GLP-1 inhibitors alongside insulin.
- The study also indicates a reduction in hospital visits related to diabetic ketoacidosis (DKA), a serious diabetes complication, and complications linked to amputations.
- This research supports the idea that GLP-1 medications, when used alongside insulin, offer an additional protective layer against severe diabetes complications.
Type 1 Diabetes and Insulin Therapy
Type 1 diabetes is an autoimmune condition in which the body attacks the insulin-producing beta cells present in the pancreas. This leaves your body with little to no insulin.
That’s why type 1 diabetes is typically managed by insulin therapy, unlike type 2 diabetes, which can be controlled with anti-diabetic medications.
Insulin remains the first-line treatment option for type 1 diabetes, but some patients still find it difficult to achieve adequate glycemic control with insulin therapy. Moreover, insulin itself comes with some side effects, like hypoglycemia and weight gain.
Additionally, Type 1 diabetes can cause alterations in gastric emptying, which may vary from delayed (gastroparesis) to accelerated.
These changes can influence postprandial glucose levels, but the primary driver of hyperglycemia is the absence of insulin production, leading to reduced portal insulin concentrations.
This deficiency, coupled with elevated glucagon levels, exacerbates hyperglycemia through increased hepatic glucose output.
Furthermore, almost half of the adult patients with type 1 diabetes are overweight or obese. There has been an unmet need for the treatment of type 1 diabetes patients who also suffer from obesity and are at risk of severe diabetes complications.
Read: Can Patients with Type 1 Diabetes Use Ozempic?
Type 1 Diabetes and GLP-1 Receptor Agonists
A recent study suggests that glucagon-like peptide-1 (GLP-1) receptor agonists can significantly reduce the risk of severe diabetes complications.
GLP-1 receptor agonists include medications like Semaglutide and Liraglutide, which are proven to improve glycemic control.
These medications work primarily by enhancing weight loss by improved insulin secretion and slowed gastric emptying.
A recent study by Epic Research reported that patients with type 1 diabetes who use GLP-1 medications along with insulin therapy have a 55% reduced risk of ED visit due to hyperglycemia, 26% decreased risk to have an amputation and are 29% less likely to have diabetic ketoacidosis related hospital visit as compared to those on insulin therapy alone. [Ref]
The above findings are summarized in the table below:
| Outcome | Risk Reduction |
| Emergency Department (ED) visits due to hyperglycemia | 55% |
| Risk of amputation | 26% |
| Diabetic ketoacidosis (DKA)-related hospital visits | 29% |
Methodology and Analysis
The study used data from the Epic Cosmos electronic health record (EHR) database with a primary focus on adult patients with type 1 diabetes.
The study compared 7,010 patients who were taking GLP-1 receptor agonists along with insulin to 304,422 patients who used only insulin for glycemic control.
The study examined emergency department (ED) visits due to hyperglycemia, diabetic ketoacidosis (DKA), and amputation-related issues.
The results showed significant reductions in ED visits in those who used GLP-1s as an adjunct to insulin therapy as compared to those who were only using insulin for glycemic control.
Moreover, the study also found a decrease in ED visits due to stroke or myocardial infarction, but the results for these findings were not statistically significant and need to be investigated in future research.
Existing Data for the Use of GLP-1 Ras in Type 1 Diabetes
Several previous studies have also focused on the positive effects of GLP-1 receptor agonists in type 1 diabetes. These medications, primarily Liraglutide and Semaglutide, are associated with gradual weight reduction and decreased requirement of total daily insulin.
In the ADJUNCT ONE trial, with 1400 T1DM patients that were randomly assigned placebo or liraglutide 1.8 mg, 1.2 mg, or 1.6 mg to insulin therapy, it was shown that Liraglutide reduced body weight, improved insulin sensitivity, and reduced daily insulin dose along with improvements in HbA1c. [Ref]
Another study also demonstrated that Liraglutide, a GLP-1 receptor agonist, when used alongside insulin, improved glycemic control and decreased insulin dose by 8 units/day. [Ref]
According to a 26-week study performed on overweight T1DM adults, GLP-1 RAs such as liraglutide cause weight loss by ensuring satiety and increased lipid oxidation. [Ref]
GLP-1 Receptor Agonists for Double Diabetes
Double diabetes is a condition in which patients with type 1 diabetes also have insulin resistance components. It’s just like someone having type 1 diabetes, along with features of type 2 diabetes.
The use of long-acting GLP-1 receptor agonists in patients with double diabetes is also being studied. Due to their improved effect on insulin sensitivity, GLP-1 receptor agonists, along with insulin,n might be a good treatment option for patients with double diabetes.
An ongoing phase 3 study, Centre Hospitalier Universitaire Dijon, is investigating the use of GLP-1 receptor agonists for double diabetes. [Ref]
Conclusion
In conclusion, this study, alongside previous research, suggests that GLP-1 receptor agonists can be a promising adjunct therapy for type 1 diabetes.
Although it reduces the risk of severe complications like hyperglycemia and amputation risks, there are still challenges that need to be studied to properly portray the risk-to-benefit ratio of this adjunct therapy.
More data is required on the use of long-acting GLP-1 receptor agonists and combination therapies with automated insulin delivery devices.
