Endocrine Abstracts

Introduction: Obesity is increasingly prevalent in type 1 diabetes (T1D), contributing to insulin resistance and metabolic-dysfunction associated steatotic liver disease (MASLD). While semaglutide has demonstrated weight loss, improved glycaemic control, and cardiovascular benefits in people with type 2 diabetes, its use in T1D remains unapproved.

Aims & Methods: This real-world study evaluates the effects of once-weekly semaglutide SQ in overweight/obese adults with T1D after 12 months of follow-up. Inclusion criteria were stable glycaemic control (ΔHbA1c <0.3%), stable body weight (Δweight <3%), and consistent total daily insulin requirement (TDI, ΔTDI <5%) over the preceding year. Changes in weight, TDI, HbA1c, and metabolic markers, including controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), were analysed.

Results: Among 42 subjects (53% male, age 46 ± 12 years, diabetes duration 28 ± 12 years, HbA1c 7.4 ± 0.8%, BMI 32.2 ± 4.3 kg/m²), 76.2% had obesity. Eight subjects discontinued treatment, mainly due to gastrointestinal intolerance. Mean relative weight loss was 13.3 ± 11.3% (P <0.001), with 76.4% attaining ≥ 5% weight loss and 61.7% attaining ≥ 10%. Obesity prevalence decreased to 29.4% (P <0.001). HbA1c decreased by 0.4 ± 0.6% (P <0.001), with 42% achieving a reduction of ≥ 0.5%. No significant changes in continuous glucose monitoring-derived parameters were observed in those with available data (n = 28). TDI reduced by 13.6 ± 16.0% (P <0.001), while TDI/kg of bodyweight remained stable. In 23 subjects with serial hepatic imaging, MASLD prevalence reduced from 82.6 to 30.4% (P <0.001), CAP decreased by 45 ± 33 dB/m, and significant fibrosis (based on LSM > 8 kPa) declined from 20.6 to 4.5% (P <0.001).

Conclusion: Semaglutide in T1D was safe, well-tolerated, and led to significant weight loss, improved glycaemic control and amelioration of MASLD.

Keywords: Type 1 diabetes, semaglutide, obesity, MASLD *manuscript accepted for publication in Diabetes Technology & Therapeutics