Type 1 diabetes patients treated with a popular medication used for diabetes and weight loss may dramatically reduce or eliminate the need for insulin, a small study conducted in Buffalo suggests.

"If these findings are borne out in larger studies over extended follow-up periods, it could possibly be the most dramatic change in treating Type 1 diabetes since the discovery of insulin in 1921,” said Dr. Paresh Dandona, senior author of the study, first published online Wednesday in the New England Journal of Medicine.

Semaglutide – whose trade names include Ozempic, Wegovy and Rybelsus – have taken endocrinology practices by storm, intriguing medical researchers who began to see remarkable results in some patients during the Covid-19 pandemic.

“These drugs have already transformed, and will gradually transform even more, the whole shape of diabetes and obesity,” Dandona said. “Our findings from this admittedly small study are, nevertheless, so promising for newly diagnosed Type 1 diabetes patients that we are now absolutely focused on pursuing a larger study for a longer period of time.” 

Ten patients at the UB Clinical Research Center in the Division of Endocrinology were studied from 2020 to 2022, after each was diagnosed within the previous six months with Type 1 diabetes.

Their average blood sugar level during the previous three months before diagnosis was 11.7 in hemoglobin A1c, much higher than the recommended 7 or below, said Dandona, SUNY distinguished professor of medicine and former chief of the Division of Endocrinology in the UB Jacobs School of Medicine and Biomedical Sciences.

Patients were treated first with a low dose of semaglutide while also taking meal-time insulin, and basal insulin used to keep a steady blood sugar level at other times. As the study continued, the dose of semaglutide was increased while mealtime insulin was reduced to avoid hypoglycemia.

“Within three months, we were able to eliminate all of the mealtime insulin doses for all of the patients,” Dandona said, “and within six months we were able to eliminate basal insulin in 7 of the 10 patients. This was maintained until the end of the 12-month follow-up period.”

About 35% to 40% of Dandona’s patients at UBMD Internal Medicine have started taking the brand name drugs since last summer, Dandona estimated.

He and fellow providers in the practice have discovered that semaglutide is better at controlling blood sugar levels and weight than traditional diabetes treatments.

Insulin has been the gold standard for a century and at this point continues to be, Dandona said.

Sulfonylureas – a type of sulfa drug – and Metformin also became part of standard care for diabetes in the 1950s.

The new brand name drugs were developed in the mid-2000s and have gradually been formulated to better stimulate pancreatic beta cells to produce more insulin and suppress alpha cells that raise blood sugar.

“On the one hand, they produce a hormone that reduces blood sugar,” Dandona said. “On the other hand, they suppress the hormone that increases blood sugar. And in addition to these effects, they affect the brain in terms of their hunger and satiety centers."

The latter promotes weight loss, a welcome outcome because roughly half of Americans with Type 1 diabetes are overweight or obese.

Gastrointestinal side effects cause about 5% of patients to stop the drug, Dandona said, “and about 10% can tolerate them and carry on.”

The cost and availability of the new brands will put them out of reach for some during the next decade or so as they remain on patent, Dandona predicted.

Each has a market rate of about $1,200 a month. Copays, depending on the quality of insurance, can range from $7.50 to $150 a month.

“In Buffalo, it's not the richest place on Earth,” Dandona said, “so I stick to the older drugs first and create a foundation for treatment. Then, if they're not controlled on those older, inexpensive drugs, I come on to these more expensive ones.”

Prices will fall as generic brands become more common, he said.

Meanwhile, when a temporary shortage hits, he and his colleagues have mixed and matched the three brands based on their availability in the region.