Semaglutide, brand names Ozempic®, Rybelsus®, and Wegovy®, is all over the news. It is FDA-approved to help people with type 2 diabetes (T2D) manage their blood glucose levels. It also decreases the risk of cardiovascular events and helps with weight loss. According to study results published in the New England Journal of Medicine [subscription required] by investigators at the State University of New York at Buffalo, it may also help newly diagnosed individuals with type 1 diabetes (T1D) make more insulin.
What Is Semaglutide?
Semaglutide is a glucagon-like peptide, or GLP-1. It helps people with T2D in various ways, including by stimulating insulin production. These drugs have been on the market since the early 2000s.
Thanks to decades of Breakthrough T1D-supported research, we know that people diagnosed with type 1 diabetes (T1D) still have functioning beta cells. They no longer make the amount of insulin needed by the body to function, but they do exist.
Preserving those beta cells, keeping them healthy and alive and, eventually, increasing their number and function through disease-modifying therapies is one of Breakthrough T1D’s key priority areas.
“The preservation of the remaining functional beta cell population is a critical component of developing disease-modifying therapies for patients with new-onset type 1 diabetes,” said Breakthrough T1D Director of Research, Joshua Vieth, Ph.D.
Study Results
The researchers in this study, who currently receive Breakthrough T1D funding to investigate the use of semaglutide later in disease to assist with glycemic control, administered the drug to 10 individuals. These individuals were between the ages of 21 and 39 in stage 3, or new-onset T1D. They began treatment with semaglutide within three months of diagnosis with the goal of preserving beta cell function. Nine individuals tested positive for GAD, an antibody which can indicate the presence of autoimmunity; one tested positive for IA-2, another autoantibody. Over the course of several months, all 1o individuals no longer had to administer insulin at mealtimes and six of the participants no longer needed basal insulin after six months. Additionally, participants saw an increase in c-peptide, which shows that their bodies were making more insulin after being on the therapy.
What Comes Next
These results are exciting, but much more work is needed.
“Overall, these are promising early results, suggesting it may be possible to extend the honeymoon period in early type 1 diabetes, and making it clear that further study is necessary into the mechanisms involved,” said Vieth.
According to Vieth, this study raises additional questions for researchers. In particular, what effect does using semaglutide to increase insulin production by the remaining beta cells have on these cells? It’s possible that this adds further stress on these cells. We need to determine what the effect of this stress will be beyond the length of this study. Will the beta cells continue to produce insulin or will insulin production decline? All of this must be investigated in a larger, follow-up study with a control group.
GLP-1’s Are a Priority for Breakthrough T1D
Breakthrough T1D has been a central player in the discovery and development of GLP-1’s for decades. In fact, a Breakthrough T1D-funded researcher named Pauline Kay Lund, Ph.D., was the first to discover GLP-1 and GLP-2. Since then, Breakthrough T1D has funded many studies to better understand this hormone, how it functions, and how it can be used to help people with T1D. In particular, Breakthrough T1D believes semaglutide has tremendous promise to improve glucose control and mitigate heart and kidney complications for individuals in stage 4, or established T1D.
That work continues today. There are several Breakthrough T1D-funded clinical trials to see how people with established T1D can benefit. This includes research led by Dr. Viral Shah at the Barbara Davis Center at the University of Colorado—and in collaboration with three other leading diabetes centers (Henry Ford Hospital, Iowa Diabetes, and the Oregon Health & Science University)—which is investigating ways semaglutide may benefit people with T1D and obesity who are using artificial pancreas (AP) systems
These drugs are also being explored by the Breakthrough T1D T1D Fund. T1D Fund portfolio company i2O Therapeutics is developing several products leveraging GLP-1s, initially for T2D, including a refillable, implantable GLP-1 device that delivers 6 month’s worth of the hormone, an oral form of long acting GLP-1, as well as a combined oral GLP-1 with Amylin (another important gut hormone).
Additionally, Code Bio, a T1D Fund portfolio company, has explored GLP-1 to target beta cells for targeted drug delivery.
Read more about the potential benefit of these drugs in people with T1D here.
