Abstract：
Introduction: More than two-thirds of patients with type 1 diabetes (T1D) are overweight (OW) and/or obese (OB) in the USA and Western Europe, resulting in insulin resistance as in type 2 diabetes. None of the currently available glucagon like polypeptide 1 (GLP-1) analogs are approved for patients with T1D. A higher dose of semaglutide has been approved by the Food and Drug Administration (FDA) for subjects with body mass index (BMI) >27 kg/m2. We evaluated the real-world use of semaglutide in patients with T1D. Methods: This was a retrospective chart review study of 50 OW or OB patients with T1D who were initiated on semaglutide and followed for 1 year. The control group comprised of 50 computer-matched patients (for sex, race, weight, BMI, and diabetes duration) during a similar time period and were not on any weight loss medications. Results: Most patients (92%) were non-Hispanic white in both arms. Mean ± standard deviation (SD) age and duration of diabetes were 42 ± 11 and 27 ± 12 years, respectively. The continuous glucose monitors (CGM), insulin pump use, baseline BMI and body weight were also similar in the two groups. Baseline glycosylated hemoglobin (HbA1c) was insignificantly lower in the semaglutide group (7.6% vs. 8.2%, respectively; P = non-significant [NS]). Total daily insulin dose (TDD) and insulin dose per kg body weight were higher in the semaglutide group at baseline with no difference in basal or prandial insulin dose. There were significantly greater declines in mean (±SD), BMI (7.9% ± 2.6%), body weight (15.9 lbs ± 5.4 lbs), HbA1c, CGM glucose SD and coefficient of variation (CV), and increase in CGM time in range (TIR) in the semaglutide group compared to the control group with no difference in insulin dose changes, time above range (TAR), or time below range (TBR). Conclusions: We conclude that use of semaglutide in patients who are OW and/or OB with T1D was effective in lowering body weight and BMI, and improving glycemic metrics in this pilot real-world study. We strongly recommend performing prospective, large-randomized clinical trials with newer GLP-1 analogs like semaglutide and tirzepatide (twin-cretin) for subjects with T1D associated with OW and/or OB.
摘要：
简介：在美国和西欧，超过三分之二的1型糖尿病（T1D）患者超重（OW）和/或肥胖（OB）。导致胰岛素抵抗，如2型糖尿病。目前可用的胰高血糖素样多肽1(GLP-1)类似物均未被批准用于患有T1D的患者。对于体重指数(BMI)>27kg/m2的受试者,食品和药物管理局(FDA)已经批准了更高剂量的司马鲁肽。我们评估了Semaglutide在T1D患者中的实际使用情况。方法：这是一项回顾性的图表回顾研究，对50名接受司马鲁肽治疗并随访1年的OW或OBT1D患者进行了回顾性研究。对照组由50名计算机匹配的患者组成(性别，种族,体重,BMI,和糖尿病持续时间）在相似的时间段内，并且没有服用任何减肥药物。结果：大多数患者（92％）在两组中都是非西班牙裔白人。平均±标准差（SD）年龄和糖尿病病程分别为42±11和27±12岁，分别。连续葡萄糖监测仪（CGM），胰岛素泵的使用，两组的基线BMI和体重也相似。司马鲁肽组的基线糖化血红蛋白（HbA1c）没有显着降低（7.6％vs.8.2%,分别；P=无显著性[NS])。基线时，司马鲁肽组的每日总胰岛素剂量（TDD）和每公斤体重的胰岛素剂量较高，基础或餐时胰岛素剂量无差异。平均值(±SD)下降幅度明显更大，BMI（7.9%±2.6%），体重（15.9磅±5.4磅），HbA1c,CGM葡萄糖SD和变异系数（CV），与对照组相比，司马鲁肽组的CGM时间范围（TIR）增加，胰岛素剂量变化无差异，高于范围的时间（TAR），或时间低于范围（TBR）。结论：我们得出结论，在患有OW和/或OB的T1D患者中使用司马鲁肽可有效降低体重和BMI。在这项试点的现实世界研究中，改善血糖指标。我们强烈建议进行前瞻性的，针对T1D与OW和/或OB相关的受试者，使用新型GLP-1类似物如司美鲁肽和替瑞平肽（twn-cretin）进行的大型随机临床试验。
