Impact of semaglutide use on glycemic and metabolic profile in adults with type 1 diabetes having overweight or obesity: A systematic review and meta-analysis

BACKGROUND: Semaglutide is not yet approved for type 1 diabetes (T1D), but increasing evidence indicates it could offer clinical benefits for T1D patients, particularly those with overweight or obesity. Currently, no systematic review or meta-analysis has assessed semaglutide's effectiveness in adults with T1D with overweight or obesity; this systematic review and meta-analysis aims to fill that knowledge gap. METHODS: Electronic databases were searched for articles on semaglutide use in adults with T1D with overweight or obesity. Co-primary outcomes were the percent changes in body weight and glycated hemoglobin from baseline; secondary outcomes were changes in total daily dose of insulin, glycemic variability, and adverse events. Statistical analysis was performed with RStudio software (Posit Software, PBC, Boston ), and results are presented as mean differences (MDs) along with 95% confidence intervals. RESULTS: Data from 8 studies involving adults with T1D having overweight/obesity (N = 274, with diabetes duration ranging from 19.7 to 33 years) were analyzed. All studies had a low risk of bias. Semaglutide use was associated with reductions in body weight from baseline at 3 months (MD -3.27% [-6.07 to -0.47]), 6 months (MD -6.53% [-8.44 to -4.63]), and 12 months (MD -7.6% [-8.16 to -7.04]). There was also a reduction in glycated hemoglobin from baseline at 3 months (MD -0.54% [-0.62 to -0.46]), 6 months (MD -0.55% [-0.71 to -0.40]), and 12 months (MD -0.6% [-0.72 to -0.48]). Three months (MD -0.05 units/kg/d [-0.06 to -0.03]) and 6 months (MD -0.07 units/kg/d [-0.13 to -0.01]) but not 12 months (MD -0.00 units/kg/d [-0.06 to 0.05]) of semaglutide therapy were associated with a reduction in total daily dose of insulin. Time in range (MD 4.62% [0.85 to 8.39]) and time above range (MD -8.97% [-16.41 to -1.53]) improved after 3 months of semaglutide use. Adverse event data were scarce and mostly gastrointestinal. CONCLUSION: In adults with T1D having overweight or obesity, short-term semaglutide effectively promotes weight loss, improves glycemic control, and reduces insulin requirements. More long-term randomized controlled trials with a diverse group of participants are needed to incorporate semaglutide into the routine clinical management of these patients.