Semaglutide's Impact On Insulin Reduction

A small University of Buffalo (UB) study found that the impact of semaglutide, the active ingredient in Ozempic, Rybelsus, and Wegovy, reduced or eliminated insulin dependency in people recently diagnosed with type 1 diabetes.

The research, published on September 7 in The New England Journal of Medicine, included 10 participants 21 to 39 years old recently diagnosed with type 1 diabetes. At the study's onset, the participants' average blood sugar levels over 90 days, or HbA1c level, was 11.7, which is above the recommended level of 7 or lower.

In addition, all participants took standard basal (slow-acting) and prandial (mealtime) insulin and followed a carbohydrate-restricted diet.

The scientists gave each participant a starting weekly dose of 0.125 mg semaglutide — a diabetes and weight loss drug known under the brand names Ozempic, Wegovy, and Rybelsus. Slowly, the team increased semaglutide to a maximum dose of 0.5 mg per week while simultaneously reducing prandial insulin.

Remarkably, within three months, all participants no longer needed to take prandial insulin. What's more, within six months of semaglutide treatment, seven participants were able to eliminate basal insulin.

In addition, at six months, the participants' average HbA1c lowered to 5.9, falling to 5.7 at 12 months.

"As we proceeded with the study, we found that even the dose of basal insulin could be reduced or eliminated altogether in a majority of these patients," said senior author Paresh Dandona, M.D., Ph.D., a SUNY Distinguished Professor in the Department of Medicine, former chief of the Division of Endocrinology in the Jacobs School of Medicine and Biomedical Sciences at UB.

Dandona says that many people newly diagnosed with type 1 diabetes still have some insulin reserve in pancreas beta cells. Specifically, 50% of the capacity is still present.

"This allowed us to hypothesize that semaglutide, which works through stimulation of insulin secretion from the beta cell, could potentially replace mealtime insulin administration," Dandona explained.

Although the researchers included a small number of participants in this study, if more extensive investigations with longer follow-up periods show similar results, the impact of semaglutide for type 1 diabetes management could be an effective option for reducing or eliminating the need for insulin in some people.

Still, drugs like Ozempic and Wegovy can cause significant side effects. For example, semaglutide has been associated with possible thyroid cancer risks, malnutrition, and stomach paralysis.

However, during the study period, the most common side effects were nausea, vomiting, and reduced appetite — resulting in weight loss for some participants. However Dandona says that weight loss associated with semaglutide might be beneficial since 50% of patients with type 1 diabetes in the United States have high BMIs or obesity.

He adds, "We were definitely surprised by our findings and also quite excited. If these findings are borne out in larger studies over extended follow-up periods, it could possibly be the most dramatic change in treating Type 1 diabetes since the discovery of insulin in 1921."