A Diabetes Breakthrough?

Treatment for Type 1 diabetes typically involves insulin injections. But findings from a recent study could usher in a new era of diabetes treatment that curtails reliance on insulin shots, and even dispenses with them altogether. The key to this new approach: semaglutide, the key ingredient in Type 2 diabetes drugs Ozempic, Wegovy and Rybelsus.

The study, led by Paresh Dandona, a SUNY Distinguished Professor and former chief of endocrinology at the University at Buffalo, involved 10 patients recently diagnosed with Type 1 diabetes.

The patients were treated first with a low dose of semaglutide, while also taking mealtime insulin and basal (background) insulin. As the study continued, semaglutide dosing was increased while mealtime insulin was reduced.

The numbers were highly encouraging. After three months of a 12-month follow-up period, researchers were able to eliminate mealtime insulin for all patients. After six months, they were able to stop basal insulin for seven of the 10 patients.

Remarkably, the patients’ mean HbA1c level (an individual’s average blood sugar level over 90 days) fell from 11.7 at original diagnosis to 5.9 at six months and 5.7 at 12 months, well below the American Diabetes Association’s recommendation of 7 or below.

For more than a decade, Dandona has been interested in how drugs developed for Type 2 diabetes might also be used for Type 1.

For example, he and his colleagues were the first to study how the Type 2 diabetes drug liraglutide might treat Type 1, in a study published in 2011. As they extended this work, said Dandona, they found that a significant portion of diabetics still have some insulin reserve in the beta cells of their pancreas, and that this reserve’s capacity is highest at the time of diagnosis.

“This allowed us to hypothesize that semaglutide, which works through stimulation of insulin secretion from the beta cell, could potentially replace mealtime insulin administration,” Dandona explained.

The researchers were thrilled to find that semaglutide could replace not only mealtime insulin administration, but basal insulin administration as well.

“We were definitely surprised by our findings and also quite excited,” he said. “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 in 1921.”