In the last couple of days at the European Association for the Study of Diabetes (EASD) 60th Annual Meeting 2024, the potential of glucagon-like peptide-1 receptor (GLP-1R) agonists in type 1 diabetes treatment was discussed. Studies show that GLP-1R agonists could improve glucose control and reduce body weight in type 1 diabetes patients if used as an add-on to insulin, without increasing the risk of hypoglycemia. According to leading data and analytics company GlobalData, the increased risk of hypoglycemia in type 1 diabetes patients is one of the largest unmet needs in this space. As such, using GLP-1R agonists to boost glucose control could be a way to mitigate the risk of hypoglycemia linked to high dosages of insulin.
The use of GLP-1R agonists as an add-on therapy to insulin in type 1 diabetes patients was investigated through a systematic review and meta-analysis of randomised controlled trials, including patients with type 1 diabetes on GLP-1R agonists. Patients on GLP-1R agonists achieved a 0.23% higher haemoglobin A1c (HbA1c) reduction compared to patients only on insulin, and they lost 4kg more bodyweight on average compared to control. Even though GLP-1R agonists usage demonstrated increased glucose control in patients, these medicines did not increase the risk for severe hypoglycemia in patients.
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Key opinion leaders (KOLs) interviewed by GlobalData mentioned that the risk of severe hypoglycemia linked to insulin usage is one of the most significant unmet needs in the type 1 diabetes space, together with the need for better glycemic control management. “As a rule, you know, 20%, 30% [of patients] hit the ADA [American Diabetes Association] [glycemic] targets…even in an era when the technology is more widely available, people still have severe hypoglycemia risk, ketoacidosis risk, obesity risk. There’s still risk for long-term complications, mental health problems”, a North American KOL told GlobalData.
Therefore, the use of GLP-1R agonists could be a great opportunity for patients whose diabetes is not completely under control with insulin, have a high risk of hypoglycemia, or need to lose weight.
The real-world off-label use of GLP-1R agonists semaglutide and tirzepatide was also assessed in obesity or overweight patients with type 1 diabetes. Results were presented at EASD 2024 and showed that there was a significant decrease in bodyweight in the semaglutide and tirzepatide groups compared to control, with 5.4% and 14% weight loss in the GLP-1R agonist-treated groups, respectively. HbA1C levels also improved in the GLP-1R agonist-treated groups compared to the controls, even though no statistically significant difference was observed between the effects of semaglutide (-0.42) and tirzepatide (-0.62) on glucose.
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Using GLP-1R agonists in combination with insulin to treat type 1 diabetes could be a way to mitigate the risk of hypoglycemia in patients while increasing glucose control. Moreover, it could be an opportunity to treat obesity and overweight patients on insulin that would otherwise be overlooked. However, prospective trials are needed to further assess the efficacy and safety of GLP-1R agonists in type 1 diabetes patients on different therapeutic regimens.
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By GlobalData
