A study focusing on the effects and safety of weekly semaglutide injections in people with newly diagnosed type 1 diabetes was recently carried out. What were the results and how do the injections affect those with type 1 diabetes?

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Since the discovery of insulin in 1921, people with type 1 diabetes have relied on injections of the synthetic hormone several times a day to stay alive and healthy.

In what could be the biggest breakthrough since insulin was discovered, a study of the weight loss drug semaglutide has shown promising results in reducing or eliminating the need for insulin injections in people newly diagnosed with type 1.

While semaglutide has long been established as a treatment for type 2 diabetes, treatment for type 1 diabetes has centred around multiple daily injections of insulin.

Most people with type 1 diabetes use two types of insulin; a long-acting (basal) injection normally given once or twice a day, and multiple short-acting (bolus) injections given before eating.

People with type 1 diabetes also need to monitor their blood glucose levels frequently to check that they are within a safe range.

So, what is semaglutide? How does it work? And could this mean the end of daily injections for those living with type 1 diabetes?

What is type 1 diabetes?

Type 1 diabetes is one of a group of conditions known as diabetes mellitus. It is a treatable, but chronic (long-term) condition that affects around one in ten people with diabetes mellitus in the UK.

Other types of diabetes mellitus include type 2 diabetes, gestational diabetes and prediabetes.

Type 1 diabetes is an autoimmune disease that occurs when your immune system mistakenly attacks its own cells; in the case of type 1 diabetes, the beta cells in the pancreas that produce insulin.

Insulin is a hormone that regulates the levels of glucose (sugar) in the blood. Without insulin, blood sugar levels can become dangerously high, which can result in a life-threatening condition known as diabetic ketoacidosis, as well as long-term complications, including kidney disease, nerve damage and diabetic retinopathy.

Type 1 diabetes primarily affects children and young adults, though anyone can get it. It is not related to lifestyle factors such as obesity and lack of exercise, as is the case with type 2 diabetes.

What is semaglutide?

Semaglutide is a type of medication known as a glucagon-like peptide-1 receptor agonist (GLP-1 RA).

It works by binding to certain receptors in the brain and triggering an increase in hormones called incretins. Incretins affect the body in several ways, including:

• Increasing the production of insulin as needed

• Reducing the amount of glucose released by your liver

• Making you feel less hungry

• Slowing the rate at which your stomach digests food, making you feel fuller for longer

Semaglutide has been used for many years to treat type 2 diabetes, and more recently, combined with diet and exercise, to aid weight loss in people with obesity.

Semaglutide is given by injection once a week. It is sold under the brand names Ozempic (for type 2 diabetes) and Wegovy (for weight loss).

What is the new study?

The study was conducted by the University of Buffalo from 2020 to 2022 and published in the New England Journal of Medicine in September 2023. It looked at the effects and safety of weekly semaglutide injections in people with newly diagnosed type 1 diabetes.

Who were the participants?

The study trialled weekly semaglutide injections in 10 newly diagnosed patients between the ages of 21 and 39. All the participants had been diagnosed with type 1 diabetes within the last three months and were taking a combination of basal (long-acting) and bolus (short acting) insulin injections.

How long did the study last?

The participants were followed up for 12 months.

What happened during the study?

Over the course of the study, the dose of semaglutide was gradually increased and the doses of both basal and bolus insulin were reduced. The participants were monitored closely throughout the study, including their:

• Blood glucose levels

• HbA1c

• C-peptide

What were the results?

After three months, all 10 patients were able to stop taking bolus insulin injections. After six months, 7 out of the 10 patients were also able to stop using basal insulin.

In addition, the participants showed an increase in C-peptide, a substance produced by the body that measures how much insulin your body is making.

The participant’s blood glucose levels greatly improved over the course of the study. Their average HbA1c, a test that measures average blood glucose levels over a 3-month period, fell from 11.7% to 5.7% after 6 months of treatment with semaglutide.

Were there any side effects?

During the study, some participants experienced mild hypoglycaemia (low blood sugar). However, this issue was resolved as the dose of semaglutide was adjusted. There were no episodes of diabetic ketoacidosis or any other serious side effects during the study. 

How does semaglutide work to treat type 1 diabetes?

In the months following diagnosis, most type 1 diabetics still have some functioning insulin-producing cells and are producing significant amounts of insulin. When they begin treatment with insulin, this reduces pressure on these remaining cells and allows them to recover temporarily. This is known as the “honeymoon phase” and can last for several months.

Weekly semaglutide injections appear to help preserve functioning beta cells, allowing the cells to continue to make insulin, and reducing or eliminating the need for daily insulin injections.

Who is the treatment suitable for?

Semaglutide appears to be suitable for patients recently diagnosed with type 1 diabetes (within the past 3 months), who still have some functioning insulin-producing cells.

What does this mean for people living with type 1 diabetes?

Though the results of the study are promising, with only 10 participants, it is too small to be conclusive. However, if the results are replicated in large-scale studies, it could provide life-changing treatment to millions facing a diagnosis of this challenging condition.

Conclusion of the study

Semaglutide injections are well-known as a treatment for type 2 diabetes and obesity.

This groundbreaking new study has highlighted the possibility of the drug as a treatment for type 1 diabetes.

Semaglutide appears to preserve still-functioning beta cells, allowing them to keep producing insulin and reducing or eliminating the need for multiple daily injections.

This study offers an exciting breakthrough in the treatment of type 1 diabetes, and early treatment with semaglutide could potentially put the disease into remission, allowing for better blood glucose management, and reducing the risk of short and long-term complications.