GLP-1 Drugs Show Promise for Teens With Type 1 Diabetes and Obesity, Small Study Finds

New case studies suggest that adding a low-dose GLP-1 medication to standard care may help teenagers with type 1 diabetes and obesity improve their weight, blood sugar control, and insulin needs. Researchers caution that larger studies are needed before these drugs can be widely recommended for this specific group.

What the Case Studies Found

Doctors in Denmark reported on two teenage girls with type 1 diabetes and obesity who took a low-dose GLP-1 drug called semaglutide (sold under brand names Ozempic and Wegovy) for one year. Both patients also continued lifestyle changes like diet and exercise.

The first patient was a 17-year-old who had lived with type 1 diabetes for 10 years. After one year on semaglutide, she:

• Lost 12 kilograms (about 26.5 pounds)
• Reduced her body mass index (BMI) from 30.1 to 26 (a BMI of 30 or higher is considered obese)
• Lowered her HbA1c (a measure of average blood sugar over three months) by 2.5%
• Cut her total daily insulin dose by 27.7 units
• Spent slightly more time with blood sugar in the healthy target range

The second patient was a 12-year-old who had type 1 diabetes for four years. She experienced:

• Weight loss of 8.4 kilograms (about 18.5 pounds)
• A BMI drop from 38 to 34.1
• A reduction in daily insulin of 53 units
• A modest improvement in HbA1c
• A 9-percentage-point increase in time spent with blood sugar in target range
• A 4-percentage-point decrease in time spent below 70 mg/dL (dangerously low blood sugar)
• A 4-percentage-point decrease in time spent above 180 mg/dL (too high blood sugar)

Importantly, neither patient had severe hypoglycemia (blood sugar below 54 mg/dL), and no major side effects occurred.

The findings were published in the journal Pediatrics by Dr. Julie Kloppenborg and colleagues at Steno Diabetes Center Copenhagen.

Why This Matters for Teens With Type 1 Diabetes

Type 1 diabetes is an autoimmune condition where the pancreas produces little or no insulin. Unlike type 2 diabetes, it is not caused by lifestyle factors. People with type 1 diabetes must take insulin every day to survive.

However, obesity is becoming more common in teenagers with type 1 diabetes. Carrying excess weight makes blood sugar harder to control and increases the risk of heart disease, which is already higher in people with diabetes. According to the researchers, many teens with type 1 diabetes and obesity struggle to manage their condition with insulin and lifestyle changes alone.

Dr. Christopher Romero, a pediatric endocrinologist at the Icahn School of Medicine at Mount Sinai in New York City, was not involved in the study but commented on its importance. He noted that poorly controlled diabetes in youth raises the risk for both macrovascular complications (like heart attack and stroke) and microvascular complications (like kidney disease, nerve damage, and vision loss) in early adulthood.

The Challenge of Treating Type 1 Diabetes With Obesity

GLP-1 receptor agonists like semaglutide are widely used to treat type 2 diabetes and obesity, including in adolescents. These drugs work by mimicking a natural hormone that helps the pancreas release insulin after meals, slows digestion, and reduces appetite.

But using them in type 1 diabetes is more complicated. People with type 1 diabetes rely on injected insulin because their bodies cannot produce it. Adding a GLP-1 drug can lower blood sugar further, raising the risk of hypoglycemia (dangerously low blood sugar). For this reason, no GLP-1 medication is currently approved for type 1 diabetes, and labels warn about the risk of hypoglycemia when used with insulin.

In these two cases, doctors only considered adding semaglutide after years of “limited success” with lifestyle changes and increasing insulin doses. Before starting the drug, they took careful safety steps:

• They reduced the patients’ mealtime insulin doses
• They reinforced continuous glucose monitoring (CGM) alerts
• They taught the families how to monitor for ketones (a sign of insulin deficiency)
• They provided structured education about recognizing and treating low blood sugar

Both patients started at a very low dose and gradually increased to 0.5 mg by month 6. If side effects occurred, dose increases were delayed.

What Experts Say About GLP-1s for Type 1 Diabetes

Dr. Romero said that conventional treatments are often not enough for patients with type 1 diabetes and obesity. “It is important to consider other interventions for our type 1 diabetes population as a means to ease their medication burden of insulin, and more importantly optimize their health,” he told MedPage Today.

He also pointed out that insulin needs vary widely in children based on age, body size, and puberty stage. “This potentially makes dosing of a GLP-1 agonist more complicated and requires well-thought-out research studies,” he said.

Previous research on GLP-1 drugs in type 1 diabetes is limited but encouraging. A small trial found that 1 mg of semaglutide reduced blood sugar and weight in adults with type 1 diabetes and obesity, with no safety problems. A small real-world study of adolescents and young adults with type 1 diabetes also reported metabolic improvements after 10 months, though it did not fully examine safety.

Despite the limited data, a nationwide study in Denmark found that prescriptions for GLP-1 drugs in people with type 1 diabetes have increased in recent years. This suggests that doctors are already using these drugs “off-label” (meaning not FDA-approved for this use) in some cases.

Practical Takeaways for Families and Caregivers

If you are caring for a teenager with type 1 diabetes and obesity, here are some key points to keep in mind:

– GLP-1 drugs are not approved for type 1 diabetes. Using them requires close supervision by a specialist experienced in both diabetes and these medications.

• Lifestyle changes remain the foundation. Diet, exercise, and behavior changes are essential for weight management and blood sugar control.
• Insulin adjustments are critical. If a GLP-1 drug is added, insulin doses will likely need to be reduced to prevent low blood sugar.
• Monitoring is key. Continuous glucose monitors, ketone testing, and frequent check-ins with a diabetes team are necessary for safety.
• Larger studies are needed. The researchers and outside experts agree that clinical trials are urgently needed to confirm the safety and effectiveness of GLP-1 drugs in teens with type 1 diabetes.

Dr. Kloppenborg and her team wrote that confirming the efficacy and safety of these drugs “could significantly enhance treatment options for adolescents with type 1 diabetes and obesity, ultimately improving their long-term metabolic and cardiovascular health trajectories.”

Both patients in the case studies remain under gradual dose increases and are closely followed by pediatric diabetes specialists who have experience with GLP-1 receptor agonists.

The Bottom Line

These two cases offer a glimpse of hope for teenagers with type 1 diabetes who are also struggling with obesity. The results suggest that adding a low-dose GLP-1 drug may help with weight loss, better blood sugar control, and lower insulin needs — all without serious side effects.

But experts emphasize that this is not a one-size-fits-all solution. Because of the risk of hypoglycemia and the complexity of dosing in growing children, any use of GLP-1 drugs in type 1 diabetes should be done only under careful medical supervision and as part of a comprehensive diabetes management plan.

For now, families should talk to their diabetes care team about all available options for managing both type 1 diabetes and obesity, including lifestyle interventions, technology like continuous glucose monitors and insulin pumps, and any emerging treatments that may be appropriate.

As more research is completed, the hope is that doctors will have clearer guidance on how to safely use these powerful medications in a population that desperately needs better tools.

Source: MedPage Today