Endocrine Abstracts

JOINT2865

Introduction: Obesity is increasingly prevalent in type 1 diabetes (T1D), contributing to insulin resistance, metabolic syndrome, and MASLD. While semaglutide has proven effective for weight loss, glycemic control, and cardiovascular benefits in type 2 diabetes, its use in T1D remains unapproved.

Aims & Methods: This real-world study evaluates the effects of once-weekly subcutaneous 1. 0 mg semaglutide in adults with T1D. Inclusion criteria were stable glycemic control (Δ HbA1c < 0. 3%), stable body weight (Δ weight < 3%), and a consistent insulin regimen (Δ insulin dose < 5%) over the preceding year. Changes in body weight, total daily insulin dose (TDI), HbA1c and metabolic markers - including estimated glucose disposal rate (eGDR), controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) - were assessed at baseline, 6 months and 12 months.

Results: Among 42 subjects (53% male, mean age 46 ± 12 years, diabetes duration 28 ± 12 years, HbA1c 7. 4 ± 0. 8%), mean BMI was 32. 0 ± 4. 6 kg/m² at baseline, with 76% classified as obese. Eight subjects discontinued treatment, primarily due to gastrointestinal intolerance. At 12 months, mean weight change was -10. 3 ± 7. 9 kg (p < 0. 001), ranging between +2. 3 to -30. 9 kg, with 76. 4% attaining ≥ 5% weight loss. Obesity rate at cohort level decreased from 76. 5 to 29. 4% (p < 0. 001). Mean HbA1c evolution was -0. 4 ± 0. 6% (p < 0. 001), with 42% reaching an HbA1c reduction of ≥ 0. 5%. Relative TDI reduction was 13. 6 ± 16. 0% (p < 0. 001) after 12 months, TDI/kg of bodyweight did not change significantly. Among those with serial hepatic imaging (n = 23), MASLD prevalence reduced from 82. 6 to 30. 4% (p < 0. 001). CAP decreased with 45 ± 33 dB/m, while the prevalence of significant fibrosis based on LSM fell from 20. 6 to 4. 5% (p < 0. 001). Insulin sensitivity based on eGDR increased significantly (5. 60 ± 2. 62 to 7. 42 ± 2. 35, p < 0. 001).

Conclusion: Adjunctive semaglutide in T1D was safe, well-tolerated, and significantly improved weight, insulin needs, glycemic control, and MASLD markers.