People recently diagnosed with Type 1 diabetes who took semaglutide — sold under the names Ozempic and Wegovy — were able cut back their insulin use after six months.Semaglutide, the ingredient in the blockbuster drugs Ozempic and Wegovy, was shown in an early study to reduce the amount of insulin people with Type 1 diabetes needed to use.
Treatment with the diabetes and weight loss drug semaglutide may allow people newly diagnosed with Type 1 diabetes to dramatically cut back or even completely stop insulin injections, a very small study published Wednesday suggests.
The drug — known more commonly as Ozempic or Wegovy — has soared in popularity in the past year, largely because of its effects on weight loss. Officially, Ozempic is approved to treat Type 2 diabetes, while Wegovy is approved for weight loss.
In the report — published as a research letter in the New England Journal of Medicine — researchers analyzed previously collected data from 10 people with Type 1 diabetes who had started taking semaglutide weekly. Three months into the treatment, all were able to stop taking insulin with meals. Within six months, seven out of the 10 were able to stop taking insulin altogether, according to the report.
Experts not involved with the study called the results exciting, but stressed that much more research is needed.
The findings surprised even the study authors.
“I was absolutely shocked that we could get rid of fast-acting insulin in three months and then basal insulin in seven out of 10 patients,” the lead author, Dr. Paresh Dandona, said, referring to two types of insulin, one fast-acting and used to blunt blood sugar spikes after eating, and the other more long-acting, meant to keep blood sugar steady throughout the day.
“It was almost like science fiction,” said Dandona, a professor of medicine at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences in New York.
People with Type 1 and Type 2 diabetes both have trouble controlling blood sugar levels. But the causes of the conditions — and how they are treated — are different.
Type 1 diabetes is an autoimmune disease. In Type 1 diabetes, the body mistakenly attacks and destroys beta cells in the pancreas that produce insulin. Insulin is a molecule that tells the body to move sugar from the blood into cells, where it can be used for energy. People with Type 1 diabetes must therefore take insulin, because their bodies cannot make it.
In Type 2 diabetes, the beta cells in the pancreas are not attacked, but they do not produce enough insulin. In addition, the body doesn’t respond well to the insulin that is produced, a condition known as insulin resistance. Drugs for Type 2 diabetes work in different ways, including lowering blood sugar, increasing insulin sensitivity and increasing insulin production.
How could semaglutide help?
Semaglutide helps with Type 2 diabetes by mimicking a hormone in the body called GLP-1, which is released in the digestive system after eating and prompts the body to make more insulin, which in turn lowers blood sugar.
In 2011, Dandona had tried treating patients with Type 1 diabetes with a related but less effective medication, liraglutide. That medication, which also mimics GLP-1, reduced the amount of insulin patients needed but not as dramatically as what he described in the new report.
When semaglutide came on the market, he was intrigued. Around that time, he said, he also learned that when people were diagnosed with Type 1 diabetes, they still had 50% of their insulin reserve intact.
“I thought why not try treating patients newly diagnosed with Type 1 diabetes and see what happens” he said.
To see whether the semaglutide was working, Dandona looked at patients’ blood sugar levels; lower levels would suggest it was having an effect. At diagnosis, the average HbA1c level (a measure of a person’s average blood sugar level over 90 days) was 11.7, far above the recommended 7 or below. Six months later, the patients’ HbA1c levels had dropped to 5.9, on average, and at 12 months, it had fallen to an average of 5.7.
Another big advantage for the patients was that their blood sugar levels did not fluctuate, but rather remained level.
Dandona and his colleagues chose to study newly diagnosed patients because the insulin reserve tends to drop as the autoimmune disease destroys more and more beta cells over time. The researchers hope that not only will patients be able to cut back on insulin, but also that semaglutide may turn out to protect beta cells. If that is the case, semaglutide could revolutionize the treatment of Type 1 diabetes, Dandona said.
“I’m very excited about this,” he said. “I believe it’s going to change the shape of treatment of Type 1 diabetes.”
Before that happens, there needs to be a much larger and longer study, Dandona said, adding that he’s already rounded up a group of diabetes investigators from various centers around the country. Once funding has been secured, the study can start.
Novo Nordisk, the maker of semaglutide, isn't doing research on Type 1 diabetes and semaglutide.
“The study in the NEJM was not sponsored by Novo Nordisk and we currently do not have any studies ongoing with semaglutide in people living with Type 1 diabetes,” company spokesperson Allison Schneider said in an email.
“While we have not had the opportunity to evaluate this data, we support research for potential advancements of treatments for patients with Type 1 diabetes as well as other serious chronic conditions,” Schneider said.
What comes next
Experts welcomed the new study, but said there needed to be more research before any changes in treatment were recommended.
“You can’t make too much of a claim based on a small, non-controlled study. We need to see more and larger studies,” Dr. Michael Natter, an endocrinologist at NYU Langone Health, cautioned.
Still, he said, he’s “extremely excited and cautiously optimistic,” adding that as a person with Type 1 diabetes, he has skin in the game.
Natter has also some evidence from his own practice that makes him think that further research will bear out the findings of the new study. He has used semaglutide in patients with obesity who also had Type 1 diabetes. Those patients not only lost weight on the medication, but “nearly all of them required less insulin and had better blood sugar control,” he said.
Choosing to focus on newly diagnosed patients was “brilliant,” said Dr. Vanita Aroda, director of diabetes clinical research at Brigham and Women’s Hospital in Boston.
The findings “are very striking,” she said. “Large studies need to be done and this is a call to action. We should be taking a look at the patient population with Type 1 diabetes and see if they can benefit from such therapies.”
Dr. Utpal Pajvani, a diabetes expert and an associate professor of medicine in the division of endocrinology at Columbia University’s Vagelos College of Physicians and Surgeons, said that the study “is very, very interesting and would warrant external validation.”
But the research had limitations: It’s retrospective and it’s possible that some of the patients may have had Type 2 diabetes, not Type 1, he said. “There’s no way to tell if they have Type 1 from the available data,” he said.
Still, “I’m intrigued and hopeful,” he added.
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