While both type 1 and type 2 diabetes involve issues with insulin—a hormone needed to absorb sugar from the bloodstream to produce energy—their methods of action are not the same. Type 1 diabetes (T1D) is an autoimmune disease in which a patient’s immune system attacks their pancreatic cells, thereby preventing the production of insulin. Type 2 diabetes (T2D), on the other hand, involves insulin resistance and a gradual loss of insulin production.
For decades, management of T1D has revolved around insulin therapy, requiring patients to balance blood sugar levels by using automated insulin delivery (AID) systems while carefully monitoring diet and physical activity.
However, a new study conducted by McGill researchers suggests that combining AID systems with semaglutide—an injectable medication that slows digestion, reduces appetite, and stimulates insulin release from the pancreas, known commercially as Ozempic—could help people with T1D gain more control over blood sugar levels while simultaneously using less insulin. This research marks a major step forward, as semaglutide has primarily been used for T2D and weight management.
Melissa-Rosina Pasqua, an assistant professor in McGill’s Division of Endocrinology and Metabolism, conducted this research with 28 T1D patients, observing the effects of semaglutide as an add-on therapy to AID.
After 11 weeks of gradually increasing semaglutide dosage, followed by four weeks on full-dose treatment while using the AID system, the study found several key benefits from employing both treatments simultaneously. Patients experienced improved blood sugar control, spending 4.8 per cent more time within their target glucose range than a placebo group.
Additionally, daily insulin requirements decreased by an average of 11.3 units, indicating a reduced need for insulin to manage blood sugar levels. Participants also saw an average of 5.3 kilograms of weight loss—a significant finding given the rising prevalence of obesity among individuals with T1D. Importantly, the treatment did not lead to a significant increase in hypoglycemia—when blood sugar levels are too low—which is a major safety concern for diabetes management.
“This was in keeping with what we see in other populations using this drug, such as weight loss, blood sugar, less insulin, but it was nice to see it in T1D. Other similar drugs have been studied in T1D, like liraglutide, but never with this form of insulin therapy, and not with such pronounced effects,” Pasqua said in an interview with The Tribune.
Even with AID systems, many people with T1D struggle to maintain stable blood sugar levels. Post-meal blood sugar spikes remain one of the biggest challenges for T1D patients, as rapid changes in glucose levels can be difficult to control. By slowing digestion and reducing the need for large insulin doses, semaglutide treatment may help prevent these extreme fluctuations.
“AID is great for overnight glucose control, but there are still issues meeting targets for daytime glucose, mostly due to meals. Semaglutide predominantly helped with this obstacle,” Pasqua said.
Despite promising results, Pasqua noted that additional research is needed before semaglutide can be widely recommended for T1D. Two participants experienced a rare condition called euglycemic ketosis, a state where the body produces ketones—a backup energy source—despite normal blood sugar levels. While this did not progress to serious complications, it underscores the need for further safety evaluations.
Additionally, some participants struggled to tolerate the highest dose of semaglutide, suggesting that personalized dosing strategies may be necessary. Future research will explore how to maximize benefits while minimizing side effects.
“It’s important to take the results with a grain of salt. This drug is not for everyone, and it’s still important to be careful of side effects,” Pasqua said.
For now, semaglutide remains an off-label option for T1D patients, but these results suggest that new treatments are on the horizon. With further research, a weekly injection could someday be a game-changer in diabetes care, offering more control over blood sugar, lower insulin needs, and improved overall health.
