Researchers from the US have found that after treatment with a drug typically used for Type 2 diabetes, newly diagnosed Type 1 diabetes patients required little to no insulin.
Treating newly diagnosed Type 1 diabetes patients with semaglutide (also known as Ozempic, Wegovy and Rybelsus) could drastically reduce or even eliminate their need for injected insulin according to the findings of a small University at Buffalo study, published 6 September 2023 in the New England Journal of Medicine.
Senior Author Dr Paresh Dandona, a Professor at the Department of Medicine and former chief of the Division of Endocrinology at University of Buffalo, said that it “could possibly be the most dramatic change in treating Type 1 diabetes since the discovery of insulin” in 1921.
“Our findings from this admittedly small study are, nevertheless, so promising for newly diagnosed Type 1 diabetes patients that we are now absolutely focused on pursuing a larger study for a longer period of time,” Professor Dandona said.
A total of 10 patients at UB’s Clinical Research Center in the Division of Endocrinology were studied from 2020 to 2022, all of whom had been diagnosed in the past three to six months with Type 1 diabetes.
The mean HbA1c level at diagnosis was 11.7, far above the American Diabetes Association’s HbA1c recommendation of seven or below, and participants were treated first with a low dose of semaglutide while also taking mealtime insulin and basal insulin.
As the study continued, semaglutide dosing was increased while mealtime insulin was reduced to avoid hypoglycaemia.
“Within three months, we were able to eliminate all the mealtime insulin doses for all of the patients, and within six months we were able to eliminate basal insulin in seven of the 10 patients,” Professor Dandona said.
“This was maintained until the end of the 12-month follow-up period, and during that time, the patients’ mean HbA1c fell to 5.9 at six months and 5.7 at 12 months.”
Professor Dandona has been interested in how drugs developed for Type 2 diabetes might be utilized in treating Type 1 diabetes as well, and he and his colleagues were the first to study how liraglutide, another drug for Type 2 diabetes, might work in patients with Type 1 diabetes in 2011.
“As we extended this work, we found that a significant proportion of such diabetics still have some insulin reserve in the beta cells of their pancreas,” Dr Dandona explained.
“This reserve is most impressive at the time of diagnosis, when 50% of the capacity is still present. This allowed us to hypothesize that semaglutide, which works through stimulation of insulin secretion from the beta cell, could potentially replace mealtime insulin administration.
“From the outset, the goal of the current study was to see if semaglutide treatment could be used to replace mealtime insulin, thereby reducing the insulin dosage, improving glycaemic control, reducing the HbA1c and eliminating potentially dangerous swings in blood sugar and hypoglycaemia.”
The most common side effects for patients were nausea and vomiting as well as appetite suppression, which led several patients to experience weight loss, a positive outcome given that 50% of patients with Type 1 diabetes in the US are overweight or obese.
“As we proceeded with the study, we found that even the dose of basal insulin could be reduced or eliminated altogether in a majority of these patients,” he said.
“We were definitely surprised by our findings and quite excited. If these findings are borne out in larger studies over extended follow-up periods, it could possibly be the most dramatic change in treating Type 1 diabetes since the discovery of insulin.”