Fellow Michigan state university Okemos, Michigan, United States
Introduction : Type 1 Diabetes Mellitus (T1DM), characterized by the autoimmune destruction of beta-cells is known to have a gradual decline in beta-cell function, with no set timeline to complete loss of endogenous insulin production. Insulin continues to be the primary treatment but adjunctive (add-on) glucose-lowering agents have been used. Alternatives therapies are still not approved for use in T1DM but are now being used by many early on in diagnosis for presumed beta-cell protection.
Case(s) Description : Our patient is a 29-year-old male with no PMH who presented to the hospital with diabetic ketoacidosis and hemoglobin A1c (HbA1C) of 12.6%. He was on basal-bolus insulin regimen for the first 3 months after his new diagnosis of diabetes. Later, he was started on semaglutide by his endocrinologist and was tapered off insulin. He showed evidence of C-peptide production with very good HbA1C control of 4.7%. HbA1c three months after starting subcutaneous semaglutide 0.25mg per week was 4.6%. Currently (almost two years after diagnosis), he is still not requiring insulin therapy and his BMI is 20.5. C-peptide level is being monitored every 3 months and has continued to be stable. Insulin antibodies, glutamic acid carboxylase and zinc transporter 8 autoantibodies were also positive and high titer at the time of diagnosis. In our patient, we found that the early initiation of semaglutide after the diagnosis of T1DM was associated with the elimination of mealtime insulin first, followed by the basal insulin. The patient also follows a healthy diet with the help of a dietitian, in addition to daily exercise.
Discussion : GLP-1 receptors are highly expressed on the surface of pancreatic beta cells, and its stimulation has been associated with cytoprotection and anti-apoptosis in all tissue types bearing the receptor. Few small studies were published for patients with T1DM showing the efficacy of early initiation of GLP-1 receptor agonists in decreasing the need for insulin or eliminating its concurrent use. This case supports the need for further dedicated trials to investigate the potential advantages of semaglutide in T1DM. Though prolonged honeymoon phase has been reported following the use of GLP-1 receptor agonists, it is unclear whether this class of medication decreases the progressive decline of beta-cell function and mass or there are other factors that differ among individuals in the population. Studies showed that maintaining a healthy lifestyle and low BMI could also be a modifiable factor to delay beta-cell destruction. This should also be investigated further.
