Can Ozempic be used to treat type 1 diabetes?

You’ve probably heard of Ozempic, publicly hailed by many as a “miracle cure” for weight loss. Whether on TikTok, YouTube, Facebook or Instagram, Ozempic is on everyone’s lips these days. However, this injectable drug was not designed and is not indicated for weight loss. In Canada, Ozempic has been approved to help people with type 2 diabetes (T2D) better manage their blood sugar levels.

According to a recent American study, this popular drug could also become a revolutionary tool for treating type 1 diabetes (T1D). Semaglutide, its active ingredient, could delay the start of insulin treatment.

What is Ozempic?

Ozempic is a highly effective drug used in the treatment of T2D to reduce blood sugar levels without the risk of hypoglycemia, and to reduce the risk of cardiovascular events in people who have a history of heart problems (e.g., heart attacks). Its active ingredient, semaglutide, acts like GLP-1, or glucagon-like peptide-1, a protein produced by the digestive tract after meals. This protein helps the pancreas produce more insulin and reduces the production of glucagon (the hormone that raises blood sugar levels) when blood sugar is high. It also helps to slow the emptying of stomach and reduce appetite, both by reducing the sensation of hunger and accelerating the feeling of satiety. These actions combined are tipping the scales: people who take Ozempic lose 6% of their initial weight on average. Data from animal studies also suggest that semaglutide may protect the insulin-producing pancreatic beta cells.

With these results, Ozempic has become the first injectable treatment for people with T2D. It is indicated when oral medication fails to achieve good control of blood sugar levels. In Canada, Ozempic is available in pre-filled pens (once-weekly doses ranging from 0.25 mg to 1 mg).

Replacing insulin with semaglutide at the onset of T1D

Researchers have looked at the impact of Ozempic on a few people living with T1D. At the time of diagnosis, a few intact beta cells may still be producing some insulin. According to a recent American study published in the New England Journal of Medicine, the proportion could be as high as 50%. The initial hypothesis of this study was that by intervening quickly at the onset of T1D, semaglutide could potentially replace insulin at mealtimes, since it stimulates the production of this hormone and most likely offers some protection to the insulin-producing cells. Between 2020 and 2022, researchers conducted a trial on 10 people aged between 21 and 39. All had been diagnosed with T1D within six months prior.

The recommended treatment for T1D, i.e. rapid-acting insulin, was administered at each meal and long-acting insulin covered the night and the time in between meals. Participants also received small doses of semaglutide (0.125 mg). Then, gradually, the dosage of semaglutide was increased (up to 0.5 mg) and the dosage of insulin reduced to avoid hypoglycemia.

Within three months, none of the participants needed insulin before meals to maintain blood sugar levels within the target range (between 4 mmol/L and 10 mmol/L). After 6 months, long-acting insulin was no longer needed for 7 out of 10 patients. This strategy was maintained for the following 12 months.

The results are quite promising: glycated hemoglobin levels (i.e.,  3-month blood sugar average) fell from 11.7% at diagnosis to 5.9% after 6 months and 5.7% after 12 months. 

A revolutionary treatment for T1D?

Not quite. In order to determine the real impact of semaglutide, the study should have had a control group of participants taking a placebo (i.e. an identical pen without the active ingredient). What’s more, it is well known that even without semaglutide, it is possible to reduce or even stop insulin in early T1D—this is known as the “honeymoon” phase. Further studies on a larger population and with a longer-term control group will be needed to confirm the results obtained by these researchers.

Should these results be confirmed, semaglutide could become the treatment of choice in the first few years after diagnosis. Its role in the long-term management of the disease will also have to be clarified. However, it seems likely that semaglutide could facilitate and improve blood sugar management for some people with T1D.

Studies have shown that semaglutide can lower glycated hemoglobin (HbA1c) by 0.3 to 0.5%, with weight loss comparable to that observed in people with T2D. Diabetes Canada said that this type of treatment may be useful for certain people with T1D, such as those who develop insulin resistance and therefore require higher doses. However, Health Canada has not approved this use. In the BETTER registry, just under 5% of participants reported using semaglutide.

There’s no doubt that we’ll be hearing a lot about this treatment in the next few years. Especially with the upcoming arrival of a new drug for people with T2D or obesity, Mounjaro. Its ingredient, tirzepatide, has a similar action to semaglutide, but achieves a higher decrease of blood sugar and bigger weight loss.