Dr. Ahmed
Mounjaro is not indicated for the treatment of Type 1 Diabetes. There have been no studies conducted so far to evaluate the role of Mounjaro in patients with Type 1 Diabetes Mellitus.
However, not all individuals with Type 1 Diabetes are lean and thin. Obesity and weight gain are nowadays common in individuals with Type 1 Diabetes.
In addition, since Type 1 diabetes is a clinical diagnosis most of the time, people may be mislabeled as having Type 1 Diabetes.
Lastly, there is a subset of patients with Type 1 Diabetes, who have insulin resistance as well. These patients may benefit from insulin sensitizers in addition to insulin.
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Is there a space for Mounjaro in the treatment of Type 1 Diabetes?
This seems very awkward to say “YES“. Rather I would say it’s OUT OF THE BOX thinking. A few type 1 diabetics who were started on Mounjaro by their endo did respond very well.
One patient reported an A1C drop from 6.9% to 5.5% in four months. The same patient also lost 50 lbs over four months.
Another patient stated that her blood glucose has never been this stable in the past ten years despite the use of expensive insulin and frequent injections.
Her A1C dropped from 9% to 7% and her insulin requirements dropped by 75% of the total daily dose.
Having said that, Treating Type 1 Diabetes patients with insulin is a must. One can never rely on the “off-label” uses of certain drugs such as Mounjaro or Ozempic based on a few reviews.
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Why is there hope for Ozempic and Mounjaro in Type 1 Diabetes?
Insulin sensitizers and weight loss medicines are required by a sub-category of Type 1 Diabetes patients.
With frequent and prolonged use of Insulin, patients may develop insulin resistance. Insulin resistance can result because of any of the following reasons [Ref]:
- Antibodies are made against insulin
- Insulin causes weight gain and lipogenesis which may increase insulin resistance
- Inflammation and oxidative stress can lead to insulin resistance
- IGF (insulin-like growth factor) can increase insulin resistance
- Prolonged use of insulin, genetic predisposition, female gender, and hormonal changes can all aggravate insulin resistance.
Ozempic and other GLP-1 analogs have been successfully tried in the early stages of LADA Diabetes.
Even Ozempic reduced the progression of LADA Diabetes to insulin-dependent Diabetes. Likewise, Mounjaro may also be tried on such patients.
Tirzepatide has been approved for weight loss. It may be another indication to use Tirzepatide in obese individuals who also have Type 1 Diabetes.
However, it should not be used to treat Type 1 Diabetes.
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In Conclusion:
Mounjaro and other novel drugs like Ozempic may need to be studied in a subset of patients with Type 1 Diabetes along with insulin who are:
- Obese or overweight
- Require high doses of insulin indicating insulin resistance
- Have uncontrolled diabetes despite frequent insulin injections
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