The use of glucagon-like peptide 1 receptor agonists (GLP-1 RA) in addition to insulin is increasingly being viewed as a method for addressing the rising prevalence of obesity in Type 1 diabetes (T1D).
Current GLP-1 RA drugs, such as semaglutide and tirzepatide, are approved for treating Type 2 diabetes (T2D) (Ozempic and Mounjaro, respectively) and obesity (Wegovy and Zepbound, respectively) but not for T1D. While insulin remains essential for treating T1D, the new thinking is that weight loss arising from the use of GLP-1 RAs would also enable insulin dose reduction and add cardiorenal benefit in those who are overweight or obese (one recent study shows that two thirds of people in the United States with T1D are also overweight or obese).
Accordingly, a related topic in the field right now is whether people with T1D who also have obesity with extreme insulin resistance should also be diagnosed with T2D. Rozalina G. McCoy, MD, associate division chief for Clinical Research, Division of Endocrinology, Diabetes, and Nutrition at the University of Maryland School of Medicine, Baltimore, commented: “A person can absolutely have both, and we need to treat them for both. I think that’s the big gap in care for many. Type 2 is just insulin resistance that has become so severe it causes hyperglycaemia. You can have both insulin resistance and deficiency, Is the best treatment higher and higher doses of insulin, or is it a GLP-1 or together with lower doses of insulin? A long time ago if you had Type 2 and Type 1 together, your only option was insulin…but now we have Type 2 medications that are pancreas agnostic, and we can use those so that patients don’t have to take very high doses of insulin, which is safer and better in the long term. We need the research, but I think we need to start shifting the paradigm away from mutually exclusive, because they’re not”.
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