Weight Gain and Glycemic Control in Adults with Type 1 Diabetes in the T1D Exchange Registry

Cardiovascular and Renal Biomarkers in Overweight and Obese Adults with Type 1 Diabetes Treated with Tirzepatide for 21 Months

Introduction: Overweight (OW) and obesity (OB) affect nearly two thirds of adults with type 1 diabetes (T1D), contributing to suboptimal glucose control, cardiovascular disease (CVD), and diabetic kidney disease (DKD). Many newer drugs such as tirzepatide (a dual-incretin) and sodium-glucose cotransporter-2 inhibitors are approved for people with type 2 diabetes associated with CVD and DKD. We evaluated CVD and DKD biomarkers with off-label long-term (21 months) use of tirzepatide in OW/OB adults with T1D. Materials and Methods: In this retrospective chart review study, we analyzed data for 84 OW/OB adults with T1D who were prescribed tirzepatide since July 2022 and had used tirzepatide for at least 6 months. Controls (n = 38) were frequency matched for age, diabetes duration, sex, glycosylated hemoglobin (HbA1c), and body mass index (BMI). Data were collected from electronic medical records before initiating tirzepatide and over 21 months of treatment. Linear mixed effects models were used to examine the changes in lipids, blood pressure, and estimated glomerular filtration rate (eGFR) over time in tirzepatide-treated adults versus controls. Results: Baseline characteristics were similar except that tirzepatide users had a slightly higher baseline BMI than controls; 35.2 ± 4.8 kg/m2 and 33.3 ± 4.2 kg/m2 (P = 0.03), respectively. Patients using tirzepatide lost significantly more weight (-59 ± 4.6 lbs [-23.4%]) compared with a gain of (+1.7 ± 5.0 lbs [+1.8%]) in controls over 21 months. The HbA1c decreased more in patients using tirzepatide than controls (-0.50 ± 0.07% and -0.24 ± 0.09%, respectively, P = 0.017). Patients using tirzepatide significantly improved total and low-density lipoprotein cholesterol, triglycerides, systolic blood pressure, and eGFR; these changes remained significant even after adjusting for weight and HbA1c. The eGFR declined significantly in controls but not in the tirzepatide users. Conclusions: We conclude that long-term use of tirzepatide in OW/OB adults with T1D results in more than 23% weight loss and sustained improvement in glucose control. Irrespective of changes in weight and/or HbA1c, we observed significant improvement in cardiovascular biomarkers and preservation of kidney function. We strongly recommend a long-term randomized control trial with tirzepatide in patients with T1D.

Unveiling the Therapeutic Potential of the Second-Generation Incretin Analogs Semaglutide and Tirzepatide in Type 1 Diabetes and Latent Autoimmune Diabetes in Adults

Type 1 diabetes mellitus (T1D) is a chronic autoimmune disease caused by the immune-mediated destruction of insulin-producing pancreatic beta cells, resulting in the lifelong need for exogenous insulin. Over the last few years, overweight and obesity have recently emerged as growing health issues also afflicting patients with T1D. In this context, the term "double diabetes" has been coined to indicate patients with T1D who have a family history of type 2 diabetes mellitus (T2D) and/or patients with T1D who are affected by insulin resistance and/or overweight/obesity and/or metabolic syndrome. At the same time, the use of second-generation incretin analogs semaglutide and tirzepatide has substantially increased on a global scale over the last few years, given the remarkable clinical benefits of these drugs (in terms of glucose control and weight loss) in patients with T2D and/or overweight/obesity. Although the glucagon-like peptide-1 (GLP-1) receptor agonists and the novel dual GIP (glucose-dependent insulinotropic polypeptide)/GLP-1 receptor agonist tirzepatide are currently not approved for the treatment of T1D, a growing body of evidence over the last few years has shown that these medications may serve as valid add-on treatments to insulin with substantial efficacy in improving glucose control, promoting weight loss, preserving residual beta-cell function and providing other beneficial metabolic effects in patients with T1D, double diabetes and latent autoimmune diabetes in adults (LADA). This manuscript aims to comprehensively review the currently available literature (mostly consisting of real-world studies) regarding the safety and therapeutic use (for different purposes) of semaglutide and tirzepatide in patients with T1D (at different stages of the disease), double diabetes and LADA.

Managing obesity in adults with type 1 diabetes

As the prevalence of obesity has reached epidemic proportions, its prevalence has also increased among adults living with type 1 diabetes mellitus. Unlike the pathophysiologic relationship between obesity and type 2 diabetes mellitus, the relationship between obesity and type 1 diabetes mellitus, and management of obesity in the setting of type 1 diabetes mellitus, have not been well reviewed. In this article, we discuss the comprehensive management of obesity in adults with type 1 diabetes mellitus, focusing on medical nutrition therapy and adjunct therapies such as weight loss-promoting medications and metabolic/bariatric surgery.

Effectiveness of Semaglutide and Tirzepatide in Overweight and Obese Adults with Type 1 Diabetes

Objective: Adults with type 1 diabetes (T1D) are increasingly overweight or obese, in part due to intensive insulin therapy. Newer non-insulin medications targeting both hyperglycemia and weight loss are approved for people with type 2 diabetes. These drugs also reduce cardiovascular disease, the major cause of mortality in people with diabetes. We assessed the real-world use of semaglutide and tirzepatide, in adults with T1D followed in a specialty diabetes clinic. Materials and Methods: This retrospective chart review included 100 adults who were prescribed semaglutide or tirzepatide (50 each) and 50 controls frequency matched for age, sex, diabetes duration, body mass index, and glycosylated hemoglobin (HbA1c) and who did not receive any weight loss medications during the study period. Data were collected prior to initiation of weight loss medications (baseline) and then for up to 1 year for each patient. Results: Matching characteristics did not differ between cases and controls. There were declines in weight in both semaglutide (-19.2 ± standard error (SE) 2.9 lbs. [9.1% body weight lost]) and tirzepatide (-49.4 ± SE 3.0 lbs. [21.4% body weight lost]) groups, and HbA1c decreased in both semaglutide (-0.54 ± SE 0.14%, P = 0.0001) and tirzepatide users (-0.68 ± SE 0.16%, P < 0.0001) over 12 months. Weight and HbA1c didn't change in controls. Conclusions: We observed weight loss of 9.1% and 21.4% and improved glucose control in semaglutide and tirzepatide users, respectively, after 1 year of off-label use. As off-label use of these drugs is increasing in patients with T1D, larger, prospective safety and efficacy trials are needed.

Efficacy and Safety of Tirzepatide in Overweight and Obese Adult Patients with Type 1 Diabetes

Introduction and Objective: Most patients with type 1 diabetes (T1D) in the United States are overweight (OW) or obese (OB), contributing to insulin resistance and suboptimal glucose control. The primary Food and Drug Administration-approved treatment for T1D is insulin, which may adversely affect weight. Tirzepatide is approved for managing type 2 diabetes, improves glucose control, facilitates weight loss, and improves cardiovascular disease outcomes. We assessed the use of tirzepatide in OW/OB subjects with T1D. Methods: This was a retrospective single-center real-world study in 62 OW/OB adult patients with T1D who were prescribed tirzepatide (treated group) and followed for 1 year. At least 3 months of use of tirzepatide was one of the inclusion criteria. Based on the inclusion criteria, this study represents 62 patients out of 184 prescribed tirzepatide. The control group included 37 OW/OB patients with T1D (computer frequency matched by age, duration of diabetes, gender, body mass index (BMI), and glucose control) who were not using any other weight-loss medications during the same period. The mean (±standard deviation [SD]) dose of weekly tirzepatide at 3 months was 5.6 ± 1.9 mg that increased to 9.7 ± 3.3 mg at 1 year. Results: The gender, mean baseline age, duration of diabetes, and glycosylated hemoglobin (HbA1c) were similar in the two groups, whereas BMI and weight were higher in the treated group. There were significantly larger declines in BMI and weight in the treated group than in controls across all time points among those in whom data were available. HbA1c decreased in the treated group as early as 3 months and was sustained through a 1-year follow-up (-0.67% at 1 year). As expected, insulin dose decreased at 3 months and throughout the study period. There were no reported hospitalizations from severe hypoglycemia or diabetic ketoacidosis. The mean glucose, time-in-range, time-above-range, SD, and coefficient of variation (continuous glucose monitoring metrics) significantly improved in the treated group. Conclusions: In this pilot (off label) study, we conclude that tirzepatide facilitated an average 18.5% weight loss (>46 pounds) and improved glucose control in OW/OB patients with T1D at 1 year. For safe use of tirzepatide in patients with T1D, we strongly recommend a large prospective randomized control trial in OW/OB patients with T1D.