Al Hayek Ayman, Klonoff David C, Al Zahrani Wael M, Ibrahim Suzan Eid, Al Dawish Mohammed A
Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA.
J Diabetes Complications. 2025 Jul;39(7):109064. doi: 10.1016/j.jdiacomp.2025.109064. Epub 2025 Apr 30.
To evaluate the long-term efficacy of a GLP-1 receptor agonist (GLP-1RA, Semaglutide) as an adjunct to insulin therapy in adults with type 1 diabetes (T1D), using continuous glucose monitoring (CGM) metrics alongside weight and metabolic outcomes.
In this retrospective chart review of adults with T1D on intensive insulin therapy, GLP-1RA was initiated and maintained for two years. Glycemic and metabolic parameters were evaluated at baseline, 12 months (T12), and 24 months (T24) during combination therapy.
A total of 67 adults with T1D (56.7 % males, 43.3 % females; mean age 31.8 years, SD: 6.11; mean diabetes duration 16.6 years, SD: 5.16) were included. By 24 months, we observed improved %TIR from 46 % to 71 % and %TIR from 28.1 % to 47.9 % (p < 0.001 for both). GRI, including CHypo and CHyper, showed sustained reductions, and glycemic variability improved, with CV% falling from 46.3 % to 33.6 % (p < 0.001). HbA1c improved from 8.2 % to 7.1 %, with total daily insulin dose decreasing from 1.4 to 0.7 IU/kg/day (p < 0.001). Body weight and lipid profile improved, with significant reductions in weight (p < 0.001), LDL (p < 0.001), and triglycerides (p < 0.05). No hospitalizations for DKA or major adverse cardiovascular events (MACE) occurred, and short discontinuation had no significant impact on metabolic or glycemic outcomes.
The adjunctive use of GLP-1RA in T1D shows potential for improving glycemic stability and metabolic parameters without increasing hypoglycemia risk. However, further studies are needed to confirm these effects across diverse populations and over more extended periods to fully establish their long-term efficacy and safety.
使用持续葡萄糖监测（CGM）指标以及体重和代谢结果，评估胰高血糖素样肽-1受体激动剂（GLP-1RA，司美格鲁肽）作为1型糖尿病（T1D）成人胰岛素治疗辅助药物的长期疗效。
在这项对接受强化胰岛素治疗的T1D成人进行的回顾性病历审查中，启动并维持GLP-1RA治疗两年。在联合治疗期间的基线、12个月（T12）和24个月（T24）时评估血糖和代谢参数。
共纳入67例T1D成人（男性56.7%，女性43.3%；平均年龄31.8岁，标准差：6.11；平均糖尿病病程16.6年，标准差：5.16）。到24个月时，我们观察到目标范围内时间百分比（%TIR）从46%提高到71%，血糖低于目标范围时间百分比从28.1%降至47.9%（两者p均<0.001）。包括低血糖事件累计发生率（CHypo）和高血糖事件累计发生率（CHyper）在内的血糖风险指标（GRI）持续降低，血糖变异性改善，血糖变异系数（CV%）从46.3%降至33.6%（p<0.001）。糖化血红蛋白（HbA1c）从8.2%改善至7.1%，每日胰岛素总剂量从1.4降至0.7IU/kg/天（p<0.001）。体重和血脂谱改善，体重（p<0.001）、低密度脂蛋白（p<0.001）和甘油三酯（p<0.05）显著降低。未发生糖尿病酮症酸中毒（DKA）住院或重大不良心血管事件（MACE），短暂停药对代谢或血糖结果无显著影响。
在T1D中辅助使用GLP-1RA显示出改善血糖稳定性和代谢参数而不增加低血糖风险的潜力。然而，需要进一步研究以在不同人群中并在更长时间内证实这些效果，以充分确立其长期疗效和安全性。
