Semaglutide as an adjunct in T1D
Novo Nordisk
Promising adult T1D adjunct evidence; obesity treatment and T1D approval are different questions.
What it is
Randomized studies in adults with T1D using automated insulin delivery found improved glucose outcomes, weight and insulin requirements. Evidence is strongest in adults with obesity; there is no US T1D glycemic indication, and ketosis and hypoglycemia still require attention.
Editorial review: .
Most recent recorded citation date: 2026-08-31. Only explicit date metadata is included; an undated citation may be newer. This does not mean every claim was reviewed on that date.
Trial status, labels and access can change between reviews. How we review the evidence · How to read the evidence
Evidence behind this assessment
Key evidence notes. Study results, product eligibility and access answer different questions.
- Who was studied?
- Study populations and analysis groups vary. Product age limits alone do not describe who was studied.See the linked studies and their populations →
- Benefit or performance
- Glycemic benefit: Editorial estimate: ADJUST-T1D found +8.8 percentage points of time in range and −0.3 percentage points HbA1c versus placebo, in adults with obesity using AID.[1]
- Important harms and treatment burden
- Safety: Editorial estimate: the crossover trial recorded two euglycemic ketosis episodes with semaglutide; gastrointestinal adverse events were common. Its small selected cohort cannot establish rare-event safety.[2]
- Approval and country access
- Marketed for other indications; obesity-label eligibility, prescribing and coverage must be checked separately.Approval, trial recruitment, local supply and funding are separate. Check the cited label or access source.
- Follow-up and remaining uncertainty
- Read the full discussion and original sources for follow-up duration and study limitations.
Research status alone does not establish approval, clinical benefit or local availability.
Editorial score: calculation and evidence
A weighted editorial judgment on a 0–100 scale, not a probability of success or a measured treatment effect. Higher criterion scores mean more favorable assessments.
Default calculation: 63 × 25 + 45 × 25 + 78 × 15 + 48 × 20 + 32 × 15 = 5310; divide by total weight 100. Unrounded weighted result: 53.1.
Editorial estimate: ADJUST-T1D found +8.8 percentage points of time in range and −0.3 percentage points HbA1c versus placebo, in adults with obesity using AID.[1]
Editorial estimate: the crossover trial recorded two euglycemic ketosis episodes with semaglutide; gastrointestinal adverse events were common. Its small selected cohort cannot establish rare-event safety.[2]
Editorial estimate: ADJUST-T1D found a placebo-adjusted 8.8 kg weight difference. That trial did not establish T1D cardiovascular or kidney outcome protection.[1]
Editorial estimate: ADJUST-T1D studied 72 adults with obesity using AID for 26 weeks. This limited population and follow-up do not establish benefit across ages, body sizes or delivery methods.[1]
Editorial estimate: ADA 2026 supports GLP-1-based obesity management in eligible adults with T1D through shared decision-making and clinical monitoring. This recommendation does not establish local prescribing access or insurance coverage.[6]
These ratings concern add-on treatment alongside insulin in T1D. Maturity reflects the T1D evidence, and safety receives substantial editorial weight because risks differ by drug and population. For example, SGLT2 inhibitors can cause ketoacidosis even without markedly high glucose; this is not exclusive to T1D. Access reflects the stated indication and region, including whether a separate obesity indication applies.
Editor’s take
A material omission from the evidence map: randomized T1D results deserve visibility, with their adult/AID/obesity limits and safety findings kept in view.
The full picture
What the randomized studies found
ADJUST-T1D randomized 72 adults with T1D, BMI ≥30 and AID for 26 weeks. Its primary target combined time in range >70%, time below 70 mg/dL <4% and weight loss ≥5%; 36% versus 0% met all three. With semaglutide up to 1 mg weekly, the placebo-adjusted change was +8.8 percentage points in time at 70–180 mg/dL (95% CI 3.9–13.7), −0.3 points in HbA1c and −8.8 kg in weight. There were two severe hypoglycemia events in each arm and no reported DKA. These figures were checked against the original abstract; the full primary report was unavailable for this review.1
A separate crossover trial randomized 28 adults, and analyzed paired glucose outcomes in 24 completers. Its primary time-in-range difference was +4.8 percentage points versus placebo (P=0.006), measured during four weeks of AID after dose escalation. Secondary comparisons were not adjusted for multiplicity. Of the 28 participants, 25 had overweight or obesity; this was not an exclusively obese cohort.2
The crossover study reported two euglycemic ketosis episodes during semaglutide treatment, without acidosis or DKA. One severe hypoglycemia event occurred during placebo dose escalation, associated with a CGM malfunction. Gastrointestinal adverse effects were common with semaglutide. These small, selected studies do not establish rare-event safety.2
A post hoc ADJUST analysis found a 22.6% reduction from baseline in daily insulin requirements at week 26 (95% CI −28.3% to −17.0%), with a larger proportional reduction in bolus than basal insulin. This is a within-group change from the same trial, not another randomized comparison or an instruction to reduce insulin by that amount.3
What happened after stopping?
An extension published on 31 August 2026 compared 16 former semaglutide users who stopped treatment with 22 former placebo users who took no GLP-1 drug during follow-up. Over 12 weeks, median time-in-range change was −3.6 versus +1.5 percentage points (adjusted P=0.044). This selected follow-up was not a new randomized withdrawal trial. It suggests that glucose benefits may diminish after stopping; the abstract was available, but detailed methods and safety tables remain unreviewed.4
Scope and access
Semaglutide remains an adjunct to insulin. These adult trials do not establish benefit in children, and evidence across body sizes and insulin-delivery methods remains limited. The US Ozempic label covers type 2 diabetes, not T1D glucose treatment. Treatment of obesity under an applicable product label is a separate question.5
ADA 2026 recommendation 8.29 supports applying obesity-management strategies, including GLP-1-based therapy, to eligible adults with T1D through shared decision-making. Changing insulin needs and ketone safety require clinical support. The product label also describes pancreatitis, retinopathy, gastrointestinal and gallbladder risks, hypoglycemia with insulin, and a boxed thyroid C-cell tumor warning; the small T1D trials cannot replace that safety information.65
Scores above are editorial comparisons of the T1D evidence, not measured efficacy percentages or prescribing recommendations.
Sources
- [1]Semaglutide in Adults with Type 1 Diabetes and Obesity (ADJUST-T1D) · Peer-reviewed study · 2025-06-23
Shah et al. ADJUST-T1D.
- [2]Semaglutide with AID in T1D: randomized crossover trial · Peer-reviewed study · 2025-01-10
Pasqua et al. Nature Medicine (2025).
- [3]ADJUST-T1D post hoc analysis of insulin-dose reduction · Peer-reviewed study · 2025-12-22
ADJUST-T1D post hoc insulin analysis.
- [4]ADJUST-T1D extension: glycemic changes after semaglutide discontinuation · Peer-reviewed study · 2026-08-31 — Abstract reviewed; selected 12-week extension, not a new randomized withdrawal trial.
Montaser et al. ADJUST-T1D extension (31 August 2026), abstract.
- [5]Ozempic US prescribing information · Regulatory decision — May 2026 revision; indication is type 2 diabetes, not T1D glycemic treatment.
Ozempic US prescribing information, May 2026 revision.
- [6]ADA Standards of Care 2026: obesity management in T1D · Peer-reviewed study · 2025-12-08
ADA Standards of Care 2026, obesity section.