TOPLINE:
The use of the GLP-1 receptor agonists (RAs) semaglutide, liraglutide, and tirzepatide (both a GLP-1 and a glucose-dependent insulinotropic polypeptide RA) led to significant weight loss in people with obesity and type 1 diabetes (T1D) over 12 months in a real-world, prospective study. The greatest reduction in body weight was seen with tirzepatide, followed by semaglutide and liraglutide. Modest improvements in A1c levels were seen with all three medications.
METHODOLOGY:
- GLP-1 RAs are key treatments for obesity, and their use in people with obesity and T1D is gaining attention for potential benefits in managing obesity-related complications and reducing insulin needs.
- Researchers conducted a real-world study at an institute in Kuwait, using prospectively collected clinical data to compare real-world effects of the three GLP-1 RAs in 250 adults with T1D and obesity (BMI ≥ 27; mean age, 34 years).
- Participants received either usual care (n = 82; 41.5% female) or tirzepatide (n = 35; 71.1% female), semaglutide (n = 36; 72.2% female), or liraglutide (n = 97; 51.5% female).
- The primary outcome was weight change from baseline to 12-month follow-up, with secondary outcomes including changes in lipid profiles and A1c levels.
- Data on complications, adverse events such as severe hypoglycemia and diabetic ketoacidosis, and treatment discontinuation were also collected.
TAKEAWAY:
- The use of all three drugs led to significant weight loss after 12 months of treatment. Weight loss was greatest with tirzepatide, with a mean reduction of 10.9% (P < .001), followed by semaglutide at 9.9% (P < .001) and liraglutide at 7.1% (P < .001).
- Adjusted weight loss was greatest with tirzepatide at 11.2% (P < .001), followed by semaglutide at 10.2% (P < .001) and liraglutide at 7.4% (P < .001) compared with usual care. Similar results were noted in propensity score-matched comparisons.
- All three drugs led to modest decreases in A1c levels, with a reduction of 0.65% seen with tirzepatide (P = .004). Semaglutide was associated with a reduction of 0.33% in A1c levels (P = .034) and liraglutide with a reduction of 0.23% (P = .017).
- Daily insulin dose was reduced by 11.4 units per day in the tirzepatide group (P = .004), by 9.0 units per day in the liraglutide group (P < .001), and by 8.3 units per day in the semaglutide group (P = .02). No severe hypoglycemia or diabetic ketoacidosis events were reported in any of the treatment groups.
IN PRACTICE:
“The weight-loss effects appear robust, but these medications should not be considered if the primary objective is glycemic control,” the authors of the study wrote. “These results support the integration of obesity medications as adjunctive therapy in people with the disease of obesity who also have type 1 diabetes,” they added.
SOURCE:
The study was led by Ebaa Al Ozairi, MD, Dasman Diabetes Institute, Kuwait City, Kuwait. It was published online in Diabetes, Obesity and Metabolism.
LIMITATIONS:
The sample sizes were small and not equal. The lack of randomization may lead to selection bias. Adverse event data were limited to severe hypoglycemia and diabetic ketoacidosis, excluding other potential events. The study did not assess body composition, so weight loss may include fat-free mass loss.
DISCLOSURES:
This study was supported by grants from the Kuwait Foundation for the Advancement of Sciences and the Ministry of Health, Kuwait. One author disclosed receiving personal fees from multiple pharmaceutical companies, including Boehringer Ingelheim and Novo Nordisk. Another author reported receiving research funding from various sources and being a shareholder in a clinic that provides clinical obesity care.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.