The use of advanced weight-loss medications, such as Ozempic and Zepbound, has surged among individuals with type 1 diabetes, sparking concerns among experts regarding their safety. A recent study published in Diabetes, Obesity and Metabolism highlights this growing trend, which includes both adults and children turning to these drugs for obesity management.

While Glucagon-like peptide-1 (GLP-1) receptor agonists were originally approved for type 2 diabetes treatment and later for weight loss, their application in type 1 diabetes remains unapproved by the U.S. Food and Drug Administration (FDA). Researchers warn that their use in this population could pose serious risks, particularly severe hypoglycemia.

“These findings highlight the urgent need for better data — including clinical trials — on the effectiveness and safety of GLP-1 receptor agonists in people with type 1 diabetes, to inform clear guidelines on their use in these patients,” said Dr. Jung-Im Shin, senior researcher and associate professor at Johns Hopkins Bloomberg School of Public Health.

Unlike individuals with type 2 diabetes, those with type 1 diabetes lack the ability to produce sufficient insulin. Historically, this condition led to weight loss due to fat and muscle breakdown. However, with insulin therapy and changing lifestyle factors, obesity rates among type 1 diabetes patients have increased, leading to greater use of GLP-1 drugs.

GLP-1 drugs work by mimicking the GLP-1 hormone, which regulates insulin and blood sugar levels while also decreasing appetite and slowing digestion. However, their impact on type 1 diabetes patients remains unclear due to a lack of dedicated clinical trials.

The study tracked over 217,000 patients with type 1 diabetes across more than 30 U.S. health systems between October 2008 and September 2023. Researchers found that obesity rates in 2- to 19-year-olds with type 1 diabetes increased from 18% to 26%, while adult obesity rates climbed from 30% to 38%.

Simultaneously, prescriptions for GLP-1 drugs saw a sharp rise—from 4% to 33% among severely obese adults and from 3% to 21% among severely obese children with type 1 diabetes.

“In the most recent periods, there were big increases in the use of semaglutide (Ozempic) and tirzepatide (Zepbound) — the most potent versions of these drugs for weight loss — which again underscores the need for clinical trial data on these patients,” said Yunwen Xu, a postdoctoral researcher at the Bloomberg School’s Department of Epidemiology.

Researchers are now conducting a more targeted study to assess the risk of severe hypoglycemia in type 1 diabetes patients using GLP-1 drugs, emphasizing the need for stringent safety guidelines before widespread use in this population.

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