Changes to insulin requirements over time with semaglutide in adults with type 1 diabetes on insulin pump therapy: A post-hoc analysis of a double-blinded, randomised, crossover trial.

BACKGROUND: There is little data on how semaglutide affects basal versus bolus insulin and dosing parameters in adults with type 1 diabetes on insulin pump therapy. METHODS: This is a post-hoc analysis of a double-blinded, randomised, crossover trial assessing semaglutide (up to 1 mg) versus placebo during automated insulin delivery (AID). This analysis focuses on the first 11 of 15 weeks where participants used their routine pump therapy with continuous glucose monitoring (CGM), where remote follow-ups were performed on days 7, 21, 32, 56, 63, and 77 (± 4 days). Changes in insulin requirements, carbohydrate input, and pump parameters over time compared to baseline were assessed, as well as the frequency of parameter adjustments. RESULTS: Twenty-six participants were included; 100% were using CGM and 81% using AID at baseline. Daily total and bolus insulin, along with carbohydrate input, were significantly reduced by day 7 and remained so, while basal was significantly reduced by day 32. By day 77, there was a median increase in carbohydrate ratios by 4.1% [-1.8, 7.7] and in correction factors by 11.2% [0.0, 20.8], and a reduction in pre-programmed basal rates by 7.9% [-12.7, -4.2]. The median time spent in hypoglycemia was rarely >4% during these follow-ups. CONCLUSIONS: Insulin needs decrease rapidly upon initiation of semaglutide use in type 1 diabetes on pump therapy, predominantly due to bolus changes from less carbohydrate consumption. While diabetes technology helps to reduce hypoglycemia, adjustments to pump dosing are still required.