Semaglutide improves glucose control in automated insulin delivery for type 1 diabetes
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Key takeaways:
- The first trial of semaglutide in patients with type 1 diabetes was reported at EASD.
- Semaglutide improved time in range vs. placebo in patients with type 1 diabetes using an automated insulin delivery system.
In a small study of patients with type 1 diabetes using an automated insulin delivery system, semaglutide improved glucose control vs. placebo, researchers reported at the European Association for the Study of Diabetes Annual Meeting.
“Despite the recent advances in diabetes care, including the invention of automated insulin delivery systems or hybrid closed-loop therapies, large trials have shown that, still, 34% to 53% of people using these therapies do not achieve HbA1c of less than 7%,” Linden Perz, a graduate student at McGill University in Montreal, said during a presentation. “In addition to this, these systems don’t address the increasing prevalence of obesity in type 1 diabetes, which is related to vascular complications as well as reduced glycemic control. Semaglutide is a GLP-1 receptor agonist that has shown improvements in both glycemic control and weight management in people with type 2 diabetes and obesity. However, the effects of this drug on people with type 1 diabetes has yet to be discussed in a clinical trial until now.”
Glucose control in type 1 diabetes
The researchers conducted a randomized, double-blind, crossover trial in 28 patients with diabetes (17 women; mean age, 45 years), of whom 24 had data available for the final analysis. Patients were randomly assigned to 12 weeks of titration of semaglutide (Ozempic/Wegovy, Novo Nordisk) up to 1 mg per day or placebo followed by 3 weeks at maximally tolerated dose, and for the first 11 weeks, remained on their standard-of-care insulin therapy, and then were switched for the last 4 weeks to McGill’s automated insulin delivery system, consisting of a Dexcom G6 continuous glucose monitor, an insulin pump (YpsoPump, Ypsomed) and a smartphone with the euGlide app and the McGill dosing algorithm, connected to the other devices by Bluetooth. After a 2-week washout period, the patients then crossed over to the opposite arm. The outcomes were analyzed based on data from the last 4 weeks on therapy, Perz said during the presentation.
The primary endpoint was time in range, defined as 3.9 mmol/L to 10 mmol/L, over the last 4 weeks of the intervention.
Compared with the placebo group, the semaglutide group had more time in range (74% vs. 69%; P = .006) and less time in hyperglycemia (24% vs. 29%; P = .006), with no difference in time in hypoglycemia, Perz said during the presentation.
In addition, total daily insulin dose was reduced in the semaglutide group (46 U/day vs. 62 U/day; P < .001), she said.
The researchers performed a post hoc analysis of the last 2 weeks of the titration period for the 12 patients using the t:slim X2 insulin pump with Control-IQ (Tandem Diabetes Care) at baseline, which showed comparable results to the period on the McGill automated insulin delivery system, she said.
Effect on HbA1c and weight
Compared with the placebo group, the semaglutide group had reduced HbA1c and weight (P < .001 for both), as well as weight-based total daily dose of insulin (P = .02), according to the researchers.
Patients with detectable levels of C-peptide had a greater reduction in HbA1c and greater increase in time in range with semaglutide than those with undetectable levels, Perz said during the presentation.
Gastrointestinal adverse events were greater in the semaglutide group than in the placebo group (72 vs. 14), while there was one case of severe hypoglycemia in the placebo group, two cases of euglycemic ketosis in the semaglutide group (one of whom withdrew from the study), no cases of diabetic ketoacidosis and one serious adverse event in the semaglutide group deemed unrelated to the study, Perz said.
“Compared to placebo, semaglutide does appear to increase time in range with automated insulin delivery use [and] decreases weight, HbA1c, insulin dose and carb intake,” Perz said during the presentation. “There is a correlation between weight reduction and glycemia, with those having greater weight reduction also having greater glycemic benefits; however, compared to placebo, there are more gastrointestinal side effects, as well as two episodes of symptomatic euglycemic ketosis.”
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Pasqua MR, et al. LBA OP 07. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 9-13, 2024; Madrid.
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