It is only through recent medical understanding that we are realizing GLP-1 receptor agonists, drugs commonly prescribed for type 2 diabetes and obesity, can be insidious. These risks are compounded and grave for those with type 1 diabetes. These medications are gaining notoriety not just for blood sugar control, but in helping patients lose weight. Healthcare providers are advocating for more caution because we do not have long-term safety information about these treatments.
The Food and Drug Administration (FDA) has approved the use of GLP-1s to treat type 2 diabetes, obesity, or both. What makes it unique is that these drugs lower blood sugar by stimulating insulin production and suppressing the secretion of glucagon. GLP-1s have been shown to provide dramatic benefits to individuals with type 2 diabetes. They increase glycemic control and decrease major adverse cardiovascular events. These medications are not approved for the treatment of type 1 diabetes. Still, a significant portion of patients with type 1 diabetes are being prescribed these drugs.
Prevalence of GLP-1 Prescriptions Among Type 1 Diabetes Patients
Based on an analysis of prescription trends from 2020 to 2023, we estimate that 17% of obese youth were prescribed GLP-1s. Almost 27% of obese adults with type 1 diabetes were prescribed GLP-1 medications. Now, healthcare providers are starting to sound the alarm against these medications. They have concerns that these drugs are appropriate for a different population that they were never designed to serve.
Over 60% of those with type 1 diabetes who were prescribed GLP-1s took one of three specific drugs: liraglutide, semaglutide, or tirzepatide. Each of these medications has shown to have at least mild positive effects. For example, liraglutide has recently been studied in regard to improvement of glycemic control and weight loss in persons with type 1 diabetes. Semaglutide is the active ingredient in the current hot drugs, Ozempic and Wegovy. Few places get the accolades that this one gets for its extraordinary effectiveness.
Medical professionals are already sounding the alarm on the dangerous off-label use of these drugs. Especially with the prospect of proving adverse side effects.
Risks Associated with Off-Label GLP-1 Use
While GLP-1s may provide certain advantages such as weight loss and cardiovascular protection, experts are cautioning against overlooking the risks. These are things like a higher risk of hypoglycemia and hyperglycemia with ketosis. The additive effect of multiple GLP-1s can cause dangerously low blood sugar levels, resulting in severe hypoglycemic events.
Dr. Marina Basina put a strong focus on the need to educate patients. She cautioned that despite the drugs’ exciting short-term effectiveness, their long-term benefits and risks are still poorly understood. Healthcare professionals are coming to a consensus that further research is due immediately. They hope to study the long-term effects of GLP-1 usage among people with type 1 diabetes.
Jung-Im Shin, MD, PhD, emphasized the necessity for further investigation. “It’s urgent that researchers investigate the health risks of taking GLP-1s in people with type 1 diabetes, especially because many are already taking them.”
The Need for Cautious Monitoring
GLP-1s have additional complications for patients with type 1 diabetes. It is imperative that physicians and patients engage in ongoing discussions of risks and benefits to make informed decisions. Surveillance for side effects is necessary, as these young people seek out providers who will help them explore new possible treatments. As the long-term safety profile of GLP-1s is still unknown, experts recommend continued monitoring.
Dr. Shin noted these medications can deliver the same benefits, such as weight loss and cardiovascular protection, that individuals with type 2 diabetes or obesity take them to achieve. He expressed concern about the increased risk of hypoglycemia that might come from that.
As additional real-world evidence on GLP-1 use in individuals with type 1 diabetes becomes available, providers must remain vigilant. They need to keep re-assessing the consequences of this approach. They should be the ones to ensure that patients are adequately informed about the risks. This allows patients to pursue treatments that better fit their unique health circumstances.
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