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Researchers are looking into treatments for type 1 diabetes that don’t involve insulin. Natasha Lazaridi/Getty Images
  • A small study showed promising results in using semaglutide to treat people with type 1 diabetes.
  • Type 1 diabetes is traditionally treated with daily insulin injections while semaglutide is only approved for people with type 2 diabetes.
  • Researchers want to expand their work to see if their results can be replicated.
  • If findings continue to show promise, this could represent a significant change in the understanding and treatment of type 1 diabetes.

Researchers from the University at Buffalo are hoping that their recent findings could pave the way to a new way of treating type 1 diabetes – one that could reduce, or even eliminate altogether, the need for insulin shots.

The findings from the small study were published this week in the New England Journal of Medicine.

Researchers took study participants with a new diagnosis of type 1 diabetes and treated them not with the traditional insulin shots, but with a semaglutide – a GLP-1 agonist used to treat type 2 diabetes that is sold under brand names such as Rybelsus and Ozempic.

The researchers said the findings were promising but will require further research and more studies to see if the results can be replicated.

However, if the results hold true, researchers say it could lead to a shift in the way that type 1 diabetes is treated.

In people with diabetes, there are issues with how the body turns food into energy.

Insulin, which is released by the pancreas to regulate how the body’s cells turn blood sugar into energy, is either ineffective or produced in insufficient quantities in a person with diabetes.

There are three types of diabetes: Type 1, which can be diagnosed at any age and is treated with injectable insulin; Type 2, which can be prevented through lifestyle changes and responds to semaglutides; and gestational diabetes, which develops in some pregnant women.

Type 1 diabetes has been treated with insulin injections ever since insulin was first isolated in a lab in 1921. While this method of treatment is effective, it requires daily treatment in order to be effective.

Semaglutides are effective at treating type 2 diabetes along with providing weight management. While they’re effective in this area, they haven’t typically been prescribed to treat type 1 diabetes.

Dr. Paresh Dandona, the study’s senior author and a professor in the Department of Medicine and former chief of the Division of Endocrinology in the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo, told Medical News Today that researchers wanted to explore how people with type 1 diabetes responded to semaglutide medications.

“In type 1 diabetes, people believe that there is no insulin reserve in the patient, so therefore you need to treat them with insulin,” he explained. “That has been in practice since 1922, when the first patient was injected with insulin. Since then, it has been assumed that all treatment of type 1 diabetes has to be with insulin and insulin alone.”

Dandona says that he and his colleagues have been exploring the effects of semaglutide and liraglutide (a similar medication sold under the brand name Victoza) since 2011.

“We discovered about four years ago from other studies that all newly-diagnosed [cases of type 1 diabetes] have 50 percent of their insulin reserves still intact, and that gave me the idea that we could use semaglutide in this group of patients,” he said.

The study was composed of 10 people, all of whom had been diagnosed with type 1 diabetes in the past three to six months.

Over a period of time, their semaglutide dosage was steadily increased as they were weaned off of their usual insulin shots.

Within three months, researchers reported, none of the participants required mealtime insulin doses and within six months, seven of the 10 participants no longer needed basal (background) insulin.

Semaglutide is a GLP-1 agonist, a relatively recent family of drugs, only having hit the market within the past decade.

These medications can be helpful not only for people with type 2 diabetes, but also for aiding in weight loss. Still, this doesn’t mean they’re a miracle drug.

Dr. Pouya Shafipour, a family and obesity medicine physician for Providence Saint John’s Health Center in California, told Medical News Today that anyone considering taking semaglutides should do so in close consultation with a doctor.

“It does, for most people, cause weight loss, but as soon as they go off, you usually see the weight creeping back on,” Shafipour explained.

Adding to this issue is the fact that weight loss is more concentrated in lean muscle rather than fat.

“It’s very important for all people to counsel them on strength training, weight training, and regularly exercising, because otherwise they’re going to become skinny fat,” Shafipour said. “Once you lose weight, up to 40 percent of that could be muscle loss, and that’s very hard to get back, especially as you get older.”

Even if further studies can replicate these findings, challenges remain.

Dandona points out that semaglutide is currently only approved to treat type 2 diabetes and are therefore not covered by insurance companies for people with type 1 diabetes.

If this treatment course continues to show promise and eventually gain widespread medical approval, it could represent a big change in quality of life for patients with type 1 diabetes.

“Instead of three shots a day, you’d have just one shot a week if we can get rid of basal insulin debt, and the other very interesting thing that we observed was that our continuous glucose monitoring in these patients, the oscillations of blood sugar, are minimal,” Dandona said. “So the risk of hypoglycemia and the ups and downs, which are typical of Type 1 diabetes, are not seen.”

“This sounds like science fiction, that you can treat type 1 diabetes without insulin,” Dandona acknowledged. “We’re going to now expand this study to make a multicenter study for a prolonged period of time to see if this turns out to be consistent, and whether the actual natural history of type 1 diabetes can be altered.”