Introduction
Managing type 1 diabetes (T1D) requires precise glucose control to minimize complications and improve quality of life. Automated insulin delivery (AID), which integrates continuous glucose monitoring (CGM) with algorithm-driven insulin dosing, is the current pinnacle of insulin therapy. However, achieving optimal glycemic control remains a challenge for many patients. A recent study published in Nature Medicine explores the potential of semaglutide, a GLP-1 receptor agonist, as an adjunct therapy to AID, demonstrating significant improvements in glycemic control, reduced insulin needs, and weight loss.
Drug Details and Technology
Semaglutide is a once-weekly subcutaneous GLP-1 receptor agonist. The study paired semaglutide with a research-based AID system, comprising the Ypsomed insulin pump, Dexcom G6 CGM, and an insulin-dosing algorithm operated via a smartphone application.
AID technology autonomously adjusts insulin dosing based on real-time glucose levels, targeting optimal glycemic ranges and reducing HbA1c levels. Despite its advantages, achieving postprandial glucose control and maintaining HbA1c below 7% remains elusive for a subset of patients.
Trial Details
Conducted at the McGill University Health Centre, the randomized, double-blind, crossover study enrolled 28 adults with T1D and an HbA1c ≤ 11%. Participants underwent a 32-week trial, including a semaglutide dose titration phase and a 28-day AID intervention. Insulin dosing was adjusted to mitigate hypo- and hyperglycemia.
Exclusion criteria included BMI ≤ 21 kg/m² and histories of pancreatitis, gallbladder disease, or specific cancers. A two-week washout period separated the crossover phases, ensuring data reliability.
Key Findings
- Glycemic Benefits: Semaglutide reduced HbA1c levels, particularly in individuals with detectable C-peptide levels. Insulin requirements were lower, and glycemic variability improved.
- Anthropometric Improvements: Significant reductions in body weight, BMI, waist, and hip circumferences were observed, correlating with improved glucose control.
- Adverse Events: Gastrointestinal side effects were common, though no diabetic ketoacidosis occurred. Two cases of euglycemic ketosis were noted during semaglutide use.
Conclusion
The study underscores semaglutide’s promise as an adjunct to AID in T1D, particularly for patients with higher BMI, yielding glycemic and weight-related benefits. Future research with larger cohorts is essential to validate its long-term safety and efficacy, especially regarding rare adverse events like euglycemic ketosis.
Vinod Khandelwal, Ph.D.
Disclaimer
The editors take care to share authentic information. In case of any discrepancies please write to newsletter@medness.org
The sponsors do not have any influence on the nature or kind of the news/analysis reported in MedNess. The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of MedNess. Examples of analysis performed within this article are only examples. They should not be utilized in real-world analytic products as they are based only on very limited and dated open-source information. Assumptions made within the analysis are not reflective of the position of anyone volunteering or working for MedNess. This blog is strictly for news and information. It does not provide medical advice, diagnosis or treatment nor investment suggestions. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
MedNess is a part of STEMPeers® which is a 501(c)(3) organization registered in PA as PhD Career Support Group. The organization helps create a growing network of STEM scientists that is involved in peer-to-peer mentoring and support.
