Type 1 diabetes: no need for insulin thanks to semaglutide?

In a recent study at the University of Buffalo, newly diagnosed type 1 diabetics were sometimes able to forego insulin altogether if they were given the active ingredient semaglutide instead. Study lead author Paresh Dandona says this “may be the most dramatic change in the treatment of type 1 diabetes since the discovery of insulin in 1921.” However, this statement should be viewed with caution, because only ten people with type 1 diabetes were examined in the study and all of these people were recently diagnosed. This makes a big difference because the diabetics were in the remission phase, which means that their bodies still produce smaller amounts of insulin. This phase lasts a few months to two years, after which the pancreas of type 1 diabetics no longer produces any insulin of its own.

Semaglutide, which is the active ingredient in the drugs Ozempic, Wegovy and Rybelsus, has been approved in Europe for the treatment of type 2 diabetes since 2018. In these people, the pancreas still produces insulin, but the amount is just not enough. Aside from their use in connection with diabetes, the medications have experienced a real hype in recent months as “weight loss injections”. Some of them are actually approved for the treatment of obesity and can mainly help people with a BMI over 30 to achieve a target weight. In a study published in the New England Journal of Medicine, patients who received one dose of semaglutide per week alongside dietary changes lost an average of about 15 percent weight after 68 weeks.

In order for the active ingredient to reach the body, semaglutide is injected into the fatty tissue using a pen (a small syringe). Just once a week at any time, regardless of meals. In type 2 diabetes, the drug works on several levels: on the one hand, when the glucose level in the blood is high, the release of insulin in the pancreas is promoted, and on the other hand, semaglutide inhibits appetite and thus ensures that less energy is absorbed from the start. This allows patients to achieve lower blood sugar levels.

That sounds good, but in practice it is used in cases of type 2 diabetes that are difficult to control – the medication is not free of side effects. Ozempic and Wegovy, for example, are currently being reviewed by the European Medicines Agency (EMA) due to serious side effects. According to the authority, data on the risk of suicidal thoughts and thoughts of self-harm will be monitored and the review should be completed in November. Additionally, there may be a connection between the use of semaglutide and thyroid cancer in diabetics. This connection could at least be observed in the rodent experiment. Overall, the long-term consequences of the medication are still comparatively unexplored.

The treatment of type 1 diabetics with semaglutide, as was carried out in the current study in the New England Journal of Medicine, is, on the other hand, something of a novelty. In type 1 diabetes, the insulin-producing cells in the pancreas are destroyed due to an incorrect immune system reaction. So you can no longer “stimulate” them. However, in the first two years of the disease there is a remission phase in which the pancreas is still active. For many diabetics, this phase is complicated because they are already taking insulin from outside, but can hardly estimate how much insulin their body still has available. A dangerous excess of insulin can occur; this is referred to as “hypoglycemia”.

From 2020 to 2022, the researchers examined the effects of administering semaglutide to ten newly diagnosed people with diabetes between the ages of 21 and 39. These people were all already injecting insulin and were able to significantly reduce the dose parallel to semaglutide therapy and in some cases even stop it completely. This shows that the drug was still able to stimulate the pancreatic cells in these people – over the entire study period of two years.

This has nothing to do with curing the disease; when the pancreas finally stops working, semaglutide no longer works and insulin must be injected. But administering semaglutide instead of insulin in the remission phase would have the decisive advantage that the former works depending on the glucose level. Only when the glucose concentration in the blood is too high does semaglutide stimulate insulin production, so that the risk of insulin excess and hypoglycemia is significantly lower in this case. The current study also shows this: the patients had better long-term blood sugar values, fewer fluctuations and fewer hypoglycemias.

The study also suggested that the remission phase of the test subjects treated with semaglutide may have lasted longer than under “normal conditions”, which could be an indication that the pancreas continues to work longer as a result of the drug. This is an exciting discovery, but since the current study only had ten participants, not much can be derived from it. Side effects of semaglutide treatment in the current study included nausea, nausea, and a severely reduced appetite.