First Expert Recommendations for Safe GLP-1 Use in Type 1 Diabetes
Off-label use of medications like Ozempic, Wegovy, Mounjaro, and Zepbound is becoming increasingly common to address weight management, insulin resistance, and diabetes related complications in type 1 diabetes. New expert recommendations provide a framework for safe use while large trials are ongoing.
People with type 1 diabetes face significant challenges managing glucose, weight, and complication risks, but have very few approved treatment options.
Even with advances in insulin formulations and advanced technologies, type 1 diabetes remains complex and demanding to manage, and elevated glucose levels are common. The prolonged high blood sugars that define diabetes carry the same complication risks in both type 1 and type 2 diabetes.
While GLP-1-based treatments have proven benefits for blood glucose and weight management, as well as reducing the risk of complications for people with type 2 diabetes, they are not yet approved for those with type 1, as needed trials are still ongoing.
Because of the need for additional treatment options, GLP-1 medications are often used off-label, meaning they can be prescribed by a healthcare provider, but are not officially approved by the FDA. That means many people with type 1 diabetes are using GLP-1s potentially without regulatory information, structured clinical guidance, or safety education.
A new consensus statement was recently published that aims to close that gap. The consensus was convened by diaTribe, chaired by Dr. Satish Garg, founder and director of the adult clinic at the Barbara Davis Center for Diabetes, and reflects the clinical and lived experience of diabetes experts from around the world.
“People with type 1 diabetes are already using these therapies, but without safe use guidelines,” said Garg. “This consensus gives clinicians practical guidance to reduce risk, support individualized and collaborative care, and stresses the importance of continuing insulin therapy in patients with type 1 diabetes, despite euglycemia and normal A1C values. Our community is anxiously awaiting the completion of trials and approvals to catch up with real-world use. We hope this document will help many in the interim.”
Many people with type 1 have heard and seen the positive impact these medications are having in type 2 diabetes management and are eager to try them too.
“Living with type 1 diabetes, I struggled with my diabetes management and weight for years, despite having access to all the approved tools and therapies. Five years ago, my doctor and I decided to try a GLP-1, and the results were life-changing,” said Julie Heverly, vice president of the Time in Range Coalition and Patient Advocacy at The diaTribe Foundation.
“We hope this consensus helps the community feel more confident in considering this option for personalized care, knowing that a group of global experts has united to provide us with safe guidance while we eagerly await our access to the medications,” Heverly said.
Even though GLP-1s and similar treatments are not yet approved for type 1, they can still be used off-label. diaTribe and more than two dozen clinicians with experience successfully incorporating these revolutionary treatments into type 1 management came together to publish a new consensus statement with recommendations to guide safe use in the type 1 population.
The consensus provides recommendations for the safe use of GLP-1 medications in type 1 management, including:
- Benefits of use in youth and adults
- Initiation and titration to reduce the risk of hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), and DKA
- Screening and educational needs
- Diabetes technologies suggestions
- Monitoring and mitigating potential risks, including medication interactions and eye, gastrointestinal, muscle, and nutritional considerations
- Instructions for discontinuation during pregnancy and surgery
- Access and equity concerns
In an effort to assist more clinicians and people with type 1 who are considering trying one of these off-label medications to personalize care and improve outcomes, diaTribe has created guides for the safe use of GLP-1-based treatments in type 1 diabetes to answer common questions and serve as a reference tool:
The statement and 35 recommendations were endorsed by the American Association of Clinical Endocrinology, Association of Diabetes Care and Education Specialists, Breakthrough T1D, Advanced Technologies & Treatments for Diabetes, the International Society for Pediatric and Adolescent Diabetes, and the International Diabetes Federation Europe.
Learn more about type 1 diabetes management here: