Endocrine Abstracts

Background: Patients with type 1 diabetes mellitus (T1DM) who have high insulin requirements may have concurrent insulin resistance, often associated with obesity or features of metabolic syndrome.

Case Report: We present case of a 17-year-old patient with long-standing T1DM and persistently high total daily insulin requirements, suboptimal glycaemic control, and features of insulin resistance, including elevated BMI. The patient was diagnosed with T1DM at the age of 7 and initially managed with multiple daily insulin injections. Insulin requirements were consistently high (>1 unit/kg/day), and between ages 11–12, ranged from 1.3 to 1.7 units/kg/day. HbA1c values fluctuated between 59–88 mmol/mol, and target glycaemic control was not achieved. An insulin pump was initiated at age 12, and metformin was later added to improve insulin sensitivity. At age 14.5 years, a closed-loop system (Control-IQ) was introduced, resulting in a modest improvement in HbA1c and time-in-range (TIR: 44–56%), but insulin requirements remained high. The patient’s BMI continued to increase, and they experienced symptoms of diabetes burnout, for which psychological support was offered. The patient had ongoing input from dietitians and continued metformin. Insulin requirements remained between 1.5–1.7 units/kg/day with high HbA1c. At the age 16.5 years, with a BMI z-score (3.02), dyslipidaemia, and elevated HbA1c, semaglutide was initiated for weight management. The dose was titrated from 0.25 mg to 1 mg weekly. The patient reported reduced insulin requirements. Patient’s HbA1c and lipid profile improved and a 5% weight loss within 4 months was noticed. After 9 months, HbA1c had improved to 60 mmol/mol, weight had decreased by 9% (BMI z-score 2.56), total daily insulin dose was reduced to 1.05 units/kg/day, and TIR improved to 61%. Despite irregular bolusing, patient reported that diabetes management felt easier and their overall well-being had improved.

Summary: Although not licensed for use in T1DM, glucagon-like peptide-1 receptor agonists may offer significant benefits in selected patients by improving glycaemic control, reducing insulin requirements, and supporting weight and metabolic management.