In a breakthrough that could reshape treatment approaches for millions of patients, new research suggests that GLP-1 receptor agonists like Ozempic and Wegovy—drugs that have gained prominence for treating type 2 diabetes and obesity—may also provide significant benefits for people with type 1 diabetes. This finding challenges the traditional separation between treatment protocols for the two forms of diabetes.
The study, published in the New England Journal of Medicine, tracked 208 adults with type 1 diabetes who were randomly assigned to receive either a once-weekly injection of semaglutide (the active ingredient in Ozempic) or a placebo for 52 weeks. Both groups continued their insulin therapy throughout the trial period.
“What we’ve observed represents a potential paradigm shift in type 1 diabetes management,” said Dr. Paresh Dandona, the study’s lead author and professor of medicine at the University of Buffalo. “These medications appear to work through mechanisms that complement insulin therapy rather than replace it.”
The results were striking: participants receiving semaglutide achieved better glycemic control with an average reduction in HbA1c levels of 0.5 percentage points compared to the placebo group. Perhaps more significantly, they required approximately 15% less insulin daily and experienced fewer episodes of severe hypoglycemia—a dangerous condition where blood sugar drops to critically low levels.
For context, type 1 diabetes is an autoimmune condition where the body’s immune system destroys insulin-producing cells in the pancreas. Unlike type 2 diabetes, which is often associated with lifestyle factors and insulin resistance, type 1 has traditionally been treated exclusively with insulin replacement therapy since its discovery in 1921.
The mechanisms behind these benefits appear multifaceted. GLP-1 agonists slow gastric emptying, which helps moderate post-meal blood sugar spikes. They also appear to reduce glucagon production—a hormone that raises blood glucose—and may have anti-inflammatory effects that could benefit the remaining insulin-producing cells in people with type 1 diabetes.
Weight loss was another notable benefit observed in the study. Participants receiving semaglutide lost an average of 9.4 pounds over the year-long trial, while the placebo group experienced minimal weight changes. This effect could have particular significance for patients struggling with weight management alongside their diabetes care.
Healthcare professionals caution that these medications would complement rather than replace insulin therapy for type 1 diabetes. “Insulin remains the cornerstone of treatment,” explained Dr. Jennifer McIntosh, endocrinologist at Toronto General Hospital, who was not involved in the study. “What these findings suggest is that we may have an additional tool to help patients achieve better outcomes with potentially fewer complications.”
The financial implications of adding GLP-1 agonists to type 1 diabetes care remain significant. These medications typically cost between $900 to $1,300 monthly without insurance coverage in Canada, raising questions about accessibility and whether public health systems and private insurers will expand coverage based on these findings.
Side effects reported in the study were consistent with those observed in type 2 diabetes patients, primarily gastrointestinal issues like nausea, vomiting, and diarrhea, which typically diminished over time for most participants.
Regulatory authorities have not yet approved GLP-1 receptor agonists for type 1 diabetes, though some endocrinologists report already prescribing them off-label for selected patients who might benefit from their effects. The study’s results may accelerate consideration for formal approval for this indication.
As research continues and medical practice evolves, the key question remains: will these medications ultimately transform standard care for the estimated 300,000 Canadians living with type 1 diabetes, or will they remain a specialized option for specific patient profiles within this diverse population?
