Doctors Caution: Hidden Risks of Weight Loss Medications for Those with Type 1 Diabetes
In recent years, there has been a noticeable surge in the use of GLP-1 medications, such as Ozempic and Zepbound, particularly among individuals with type 1 diabetes. This shift is largely attributed to escalating obesity rates within this group. While these weight-loss medications show great promise, experts caution that individuals with type 1 diabetes may face serious side effects when using them.
GLP-1 medications, which include popular options like Ozempic and Mounjaro, have garnered significant attention, with nearly 15 million Americans trying these drugs at some point in their lives. However, one demographic that raises concerns among healthcare providers is those with type 1 diabetes.
According to a study published in March, both children and adults diagnosed with type 1 diabetes are increasingly utilizing GLP-1 medications. This increase is seen as a reaction to the alarming rise in obesity among these individuals, which has escalated from 30% in 2008 to 38% in 2023.
While the FDA has approved GLP-1 medications primarily for managing type 2 diabetes and obesity, none have officially been authorized for the treatment of type 1 diabetes, sometimes abbreviated as T1D. Prior studies have indicated potential risks associated with GLP-1s for those with type 1 diabetes, indicating a need for caution.
As Dr. Jung-Im Shin, a senior study author and associate professor of epidemiology at Johns Hopkins Bloomberg School of Public Health, states, “While these medications may offer benefits such as weight loss and cardiovascular protection—similar to those seen in people with type 2 diabetes or obesity—there are concerns about an increased risk of hypoglycemia,” which refers to dangerously low blood sugar levels.
Understanding Type 1 Diabetes and GLP-1 Medications
Type 1 diabetes is a chronic condition that primarily develops in childhood, impacting roughly 10% of all individuals with diabetes. This disease occurs when the pancreas fails to produce adequate insulin, the hormone that facilitates energy by transferring sugar from the bloodstream to the cells. If left untreated, high blood sugar levels can lead to severe complications, affecting the heart, kidneys, nerves, and eyes.
Typically, patients diagnosed with T1D need to administer insulin via injections or pumps. Traditionally, type 1 diabetes has been associated with individuals maintaining a healthy or average weight, yet the number of obese individuals within this demographic has risen significantly. Particularly concerning is the surge in obesity rates among Black and Hispanic youth diagnosed with type 1 diabetes.
- Intensive insulin treatment may sometimes contribute to weight gain.
- Individuals may overconsume food or reduce physical activity to avoid hypoglycemia, a common issue with the condition.
Dr. Marina Basina, a clinical endocrinologist with Stanford Medicine, notes, “The rise in obesity rates has led to an increased interest in the use of this class of drug for overweight and obese individuals with T1D.” Research indicates that between 2020 and 2023, approximately 17% of obese youth and 27% of obese adults with type 1 diabetes were prescribed GLP-1s. A significant portion of these prescriptions were for medications such as liraglutide, semaglutide (the active ingredient in Ozempic and Wegovy), or tirzepatide, marketed as Zepbound and Mounjaro.
Potential Risks Associated with GLP-1 for Type 1 Diabetes
Dr. Shin explains that GLP-1 medications function by enhancing insulin production while suppressing the release of glucagon, a hormone that elevates blood sugar levels. They offer notable benefits for type 2 diabetes patients, including improved glycemic control, enhanced insulin activity, and protection for the heart and kidneys. However, it remains unclear how these drugs will affect those with type 1 diabetes in a similar manner.
Some studies have indicated that liraglutide can improve glycemic control, promote weight loss, and enhance insulin efficacy in type 1 diabetes patients. Still, it has also been linked to increased risks for two specific conditions:
- Hypoglycemia: This risk exacerbates when GLP-1s are combined with insulin, potentially leading to dangerously low blood sugar levels.
- Hyperglycemia with ketosis: This condition denotes high blood sugar alongside elevated ketone levels, signifying the body is using fat instead of glucose for energy.
Shin states, “The combined effect can lower blood sugar too much, which may lead to hypoglycemia.” Conversely, if the insulin dosage is decreased while taking a GLP-1, as some healthcare providers may recommend, patients may risk experiencing high blood sugar.
Considerations for Using GLP-1 Medications with Type 1 Diabetes
Given the rising number of individuals with type 1 diabetes currently using GLP-1 medications, Dr. Shin urges further investigation into the associated health risks. Long-term studies are crucial to provide clearer clinical guidance on how individuals with T1D can safely use GLP-1s.
In the interim, it is vital for healthcare providers and T1D patients to carefully assess the potential benefits versus risks when considering GLP-1 medications. Dr. Basina emphasizes the importance of communicating to patients that, while these drugs may yield short-term efficacy, the long-term implications—both benefits and risks—remain inadequately understood.
