Semaglutide Treatment for Type 1 Diabetes: Promising Results and Potential Implications

2023-09-07 14:36:00

by Inca Zimmerman

As of September 07, 2023, 4:36 p.m

Semaglutid is the active ingredient in the “weight loss injections” Ozempic and Wegovy, but was originally developed for the treatment of type 2 diabetes. A current study is now testing semaglutide in type 1 diabetics.

In one current study from the University of Buffalo, newly diagnosed type 1 diabetics have sometimes been able to do without insulin altogether if they were given the active ingredient semaglutide instead. The study’s lead author, Paresh Dandona, says this could be “perhaps the most dramatic change in the treatment of type 1 diabetes since the discovery of insulin in 1921.” However, this statement should be treated with caution, because the study only examined ten people with type 1 diabetes and all of these people were newly diagnosed. This makes a big difference because the diabetics were then in remission, which means their bodies are producing even smaller amounts of insulin. This phase lasts from a few months to two years, after which the pancreas of type 1 diabetics no longer produces any insulin of their own.

Weight loss thanks to “weight loss injection” Wegovy?

Semaglutide, the active ingredient in the drugs Ozempic, Wegovy and Rybelsus, has been approved in Europe for the treatment of type 2 diabetes since 2018. In people with this disease, the pancreas still produces insulin, just not enough. Aside from the use in connection with diabetes, the drugs have experienced a real hype in recent months as “weight loss injections”. Some of them are actually approved for the treatment of obesity and can mainly help people with a BMI over 30 to achieve a target weight. In a study published in the New England Journal of Medicine, patients who received one dose of semaglutide per week in addition to dietary changes lost an average of about 15 percent in weight after 68 weeks.

Mode of action: Semaglutide lowers blood sugar

To get the drug to the body, semaglutide is injected into fatty tissue using a pen (a small syringe) just once a week at any time, regardless of meals. At Diabetes Typ 2 The drug works on several levels: on the one hand, when the glucose level in the blood is high, the release of insulin in the pancreas is promoted, on the other hand, semaglutide inhibits appetite and thus ensures that less energy is consumed from the outset. This allows patients to achieve lower blood sugar levels.

Side effects of Ozempic and Wegovy have hardly been researched so far

That sounds good, but it is used in practice in cases of type 2 diabetes that are difficult to control – the drug is not without side effects. Ozempic and Wegovy, for example, are currently being reviewed by the European Medicines Agency (EMA) for serious side effects. This is about indications that suicidal thoughts and thoughts of self-harm can occur after ingestion, according to the authority. The review is expected to be completed in November.

Also, there may be a link between semaglutide use and thyroid cancer. Such a correlation was indicated in an experiment with rodents. Overall, however, the long-term effects of the drugs are still comparatively unexplored.

Pancreas: Type 1 diabetes has a remission phase

The treatment of type 1 diabetics with semaglutide, as described in the current study in New England Journal of Medicine was carried out, is rather a novelty. In type 1 diabetes, the insulin-producing cells in the pancreas are destroyed due to an incorrect reaction of the immune system. So you can no longer “stimulate” them.

In the first two years of the disease, however, there is a remission phase in which the pancreas is still active. This phase is complicated for many diabetics because they are already taking insulin from the outside, but can hardly estimate how much insulin the body is still making available. A dangerous excess of insulin can develop, this is referred to as “hypoglycaemia”.

People with type 1 diabetes are dependent on a continuous supply of insulin over the long term. For example with such an insulin pump. Image rights: imago images/Spencer Grant

Semaglutide also stimulates insulin production in type 1 diabetes

From 2020 to 2022, the researchers examined the effects of the administration of semaglutide in ten newly diagnosed people aged 21 to 39 with diabetes. These people were all already injecting insulin and were able to greatly reduce the dose parallel to the semaglutide therapy, and in some cases even stop it altogether. This shows that the drug was still able to stimulate the cells of the pancreas in these people – over the entire two-year study period.

This has nothing to do with curing the disease, when the pancreas finally stops working, semaglutide no longer works and insulin has to be injected. But the administration of semaglutide instead of insulin would have the decisive advantage in the remission phase that the former acts depending on the glucose level. Semaglutide only stimulates insulin production when the glucose concentration in the blood is too high, so that the risk of insulin excess and hypoglycaemia is significantly lower in this case. This is also shown by the current study: The patients had better long-term blood sugar values, fewer fluctuations and less hypoglycaemia.

Is the pancreas active longer thanks to semaglutide?

The study also indicated that the remission phase of the subjects treated with semaglutide may have lasted longer than under “normal conditions”, which could indicate that the drug also keeps the pancreas working longer. This is an exciting discovery, since the current study only had ten participants, not much can be derived from it. Side effects of semaglutide treatment in the current study included nausea, vomiting and a severely reduced appetite.

The Study Semaglutide in Early Type 1 Diabetes was published in the New England Journal of Medicine and linked here – but unfortunately not accessible completely free of charge.

A recommended article in the Deutsches Ärtztblatt from 2020 on the effect of semglutide medication in type 2 diabetes You will find here.