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Glucagon-like peptide-1 agonists (GLP-1 RAs) have been proven to be effective in the management of type 2 diabetes mellitus due to the benefits of hemoglobin A1c (HgA1c) reduction, weight loss and potential deintensification of insulin therapy. GLP-1 RAs are underutilized in the treatment of type 1 diabetes mellitus (T1DM), where exogenous insulin remains the mainstay therapy. The aim of our study was to evaluate how the initiation of GLP-1 RAs in individuals with T1DM has effects on HgA1c, weight loss, BMI, total daily insulin (TDI), and time in range (TIR). We performed a retrospective analysis of nine patients ages 27-73 with T1DM at an endocrinology academic center from 2019 to 2024. Electronic medical records were reviewed for the following data: HgA1c, BMI, weight, TDI, and TIR and were followed within 90 days of initiating GLP-1 RAs. These included exenatide, dulaglutide, and semaglutide. Patients who were using continuous glucose monitoring (CGM) devices and receiving insulin subcutaneously via insulin pens or insulin pumps were included. A paired-samples t-test was conducted to compare the data before and after initiating GLP-1 RAs. For TIR, one patient was excluded due to no reporting of initial TIR in the chart. There was a significant decrease in the HgA1c after initiating GLP-1 RAs (M=7.1%, SD=1.0) than before initiating GLP-1 RAs (M=8.0%, SD=1.2); t(8)=-4.16, p=0.001. There was also a significant increase in TIR after initiating GLP-1 RAs (M=71%, SD=13) than before initiating GLP-1 RAs (M=48%, SD=21); t(7)=2.33, p=0.026. There was no significant difference in weight (M=210 lbs, SD=39.1) vs (M=213 lbs, SD=40.6), t(8)= -1.098, p-value=0.15, BMI (M=34.3 kg/m2, SD=6.3) vs (M=35.1 kg/m2, SD=6.3), t(8)=-1.45, p-value=0.092, or TDI (M=95.5 units, SD=90.6) vs (M=102.8, SD=102.1), t(8)=-0.89, p-value=0.20. Our study showed that adjunctive therapy with GLP-1 RAs in T1DM patients was effective in glycemic control by decreasing HgA1c and increasing TIR. There was no significant change in weight, BMI, or TDI.
Shahid et al. (Wed,) studied this question.