GLP-1 Receptor Agonists in Overweight and Obese Individuals With Type 1 Diabetes Using an Automated Insulin Delivery Device: A Real-World Study.

IF 4.1 Q2 ENDOCRINOLOGY & METABOLISM Journal of Diabetes Science and Technology Pub Date : 2024-10-17 DOI:10.1177/19322968241289438

Pernille Holmager, Merete Bechmann Christensen, Kirsten Nørgaard, Signe Schmidt

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Abstract

Introduction: Automated insulin delivery (AID) systems have improved glycemic control in individuals with type 1 diabetes (T1D) but overweight and increased cardiovascular risk remain a challenge. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are associated with improved cardiometabolic profile but are currently not approved for the treatment of T1D.

Material and methods: Individuals with T1D at Steno Diabetes Center Copenhagen, Denmark, treated with AID and off-label GLP-1 RA for at least six months between January 2017 and May 2024 were included in a retrospective chart review study.

Results: Nineteen individuals with (median [range]) age 42 (24-60) years were included. At GLP-1 RA initiation, hemoglobin A1c (HbA1c) was 7.3% (6.1%-8.7%), HbA1c 56 (43-72) mmol/mol, body weight 91.5 (78.0-115.0) kg, and body mass index 35.4 (27.0-42.0) kg/m². Time in range was 74% (29%-82%), time above range 25% (18%-71%) while time below range was 1% (0%-5%). After six months of treatment, body weight changed -11% (-22% to -3%; P = .001) and total daily insulin dose changed -15.1 (-32.5 to -8.2) IU (P = .004). There were no significant changes in HbA1c or other glucose measures. One person developed ketoacidosis caused by infusion set failure, but none reported severe hypoglycemia.

Conclusion: Glucagon-like peptide-1 receptor agonist as add-on therapy for six months in individuals with obesity and AID-treated T1D led to considerable weight loss and a reduction in insulin dose.

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GLP-1 受体激动剂在使用胰岛素自动给药装置的超重和肥胖 1 型糖尿病患者中的应用：真实世界研究

简介：胰岛素自动给药系统（AID）改善了 1 型糖尿病（T1D）患者的血糖控制，但超重和心血管风险增加仍然是一个挑战。胰高血糖素样肽-1受体激动剂（GLP-1 RAs）可改善心血管代谢状况，但目前尚未被批准用于治疗T1D：一项回顾性病历研究纳入了丹麦哥本哈根斯泰诺糖尿病中心的T1D患者，他们在2017年1月至2024年5月期间接受了AID和标签外GLP-1 RA治疗至少6个月：19名患者（中位数[范围]）的年龄为42（24-60）岁。开始使用 GLP-1 RA 时，血红蛋白 A1c (HbA1c) 为 7.3% (6.1%-8.7%)，HbA1c 为 56 (43-72) mmol/mol，体重为 91.5 (78.0-115.0) kg，体重指数为 35.4 (27.0-42.0) kg/m2。在治疗范围内的时间占 74%（29%-82%），高于治疗范围的时间占 25%（18%-71%），低于治疗范围的时间占 1%（0%-5%）。治疗 6 个月后，体重变化为 -11%（-22% 至 -3%；P = .001），每日胰岛素总剂量变化为 -15.1（-32.5 至 -8.2）IU（P = .004）。HbA1c 或其他血糖指标没有明显变化。一人因输注装置故障而出现酮症酸中毒，但没有人报告严重低血糖：结论：胰高血糖素样肽-1 受体激动剂作为附加疗法，对肥胖和接受过 AID 治疗的 T1D 患者进行为期 6 个月的治疗，可显著减轻体重并减少胰岛素剂量。

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来源期刊

Journal of Diabetes Science and Technology Medicine-Internal Medicine

CiteScore

7.50

自引率

12.00%

发文量

148

期刊介绍： The Journal of Diabetes Science and Technology (JDST) is a bi-monthly, peer-reviewed scientific journal published by the Diabetes Technology Society. JDST covers scientific and clinical aspects of diabetes technology including glucose monitoring, insulin and metabolic peptide delivery, the artificial pancreas, digital health, precision medicine, social media, cybersecurity, software for modeling, physiologic monitoring, technology for managing obesity, and diagnostic tests of glycation. The journal also covers the development and use of mobile applications and wireless communication, as well as bioengineered tools such as MEMS, new biomaterials, and nanotechnology to develop new sensors. Articles in JDST cover both basic research and clinical applications of technologies being developed to help people with diabetes.