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• Posted March 31, 2025

More Type 1 Diabetics Are Obese, Taking GLP-1 Drugs

Use of cutting-edge weight-loss drugs like Ozempic and Zepbound has increased dramatically among people with type 1 diabetes, raising safety concerns among experts, a new study says.

Both adults and children with type 1 diabetes are taking the drugs more often to manage obesity, researchers reported in the journal Diabetes, Obesity and Metabolism.

The problem is that these Glucagon-like peptide-1 (GLP-1) drugs were initially approved to treat type 2 diabetes, and later received approval as weight-loss medications, researchers said.

Their use in type 1 diabetes is not approved by the U.S. Food and Drug Administration and raises potential safety concerns, researchers explained.

There's also concern that using the GLP-1 drugs will put people with type 1 diabetes at greater risk for severe bouts of 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,” senior researcher Dr. Jung-Im Shin, an associate professor at Johns Hopkins Bloomberg School of Public Health, said in a news release.

People with type 1 diabetes are born without the ability to make enough insulin for their bodies, while those with type 2 diabetes develop insulin resistance over time.

Historically, people with type 1 diabetes have tended to be thin, because their insulin deficiency led to the breakdown of their fat and muscle for energy, causing weight loss, researchers said in background notes.

But insulin treatment for type 1 diabetes combined with today’s society have caused obesity rates to increase in those patients – and along with that, the use of GLP-1 drugs.

GLP-1 drugs mimic the GLP-1 hormone, which helps control insulin and blood sugar levels, decreases appetite and slows digestion of food.

For the new study, researchers tracked more than 217,000 patients with type 1 diabetes from more than 30 health systems across the U.S. between October 2008 and September 2023.

During that period, obesity among 2- to 19-year-olds with type 1 diabetes rose from 18% to 26%, and from 30% to 38% among adults 20 and older.

Prescriptions for GLP-1 drugs rose even faster, climbing from 4% to 33% among severely obese adults with type 1 diabetes and 3% to 21% among severely obese children, results show.

“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 in the Bloomberg School’s Department of Epidemiology.

Researchers are following up with a more targeted study looking into the risk of severe hypoglycemia among people with type 1 diabetes using GLP-1 drugs.

More information

The National Institutes of Health has more on diabetes treatments.

SOURCE: Johns Hopkins Bloomberg School of Public Health, news release, March 26, 2025