The Effects of Adding Semaglutide to High Daily Dose Insulin Regimens in Patients With Type 2 Diabetes

Background: Escalating doses of insulin required with progression of type 2 diabetes may lead to weight gain. Weight loss associated with semaglutide may be beneficial. However, data on the use of semaglutide in patients requiring high daily doses of insulin are currently lacking. Objective: The purpose of this project was to evaluate the impact of semaglutide on total daily dose (TDD) of insulin when initiated in patients with type 2 diabetes mellitus (T2DM) on high daily doses of insulin. Secondary objectives assessed included changes in weight, body mass index (BMI), blood pressure, heart rate, and diabetes and blood pressure medications. Methods: This IRB exempt retrospective medical record review included patients with T2DM prescribed semaglutide and at least 100 units TDD of insulin between January 1, 2019, and December 31, 2019. Results: Of the 72 patients included, the TDD of insulin decreased from baseline to 6 months (183 +/- 98 units and 143 +/- 99 units, P < 0.001). Average A1c and body weight also decreased from baseline to 6 months (8.9% +/- 1.3% and 7.6% +/- 1.5%, P < 0.001 and 123.9 +/- 23.5 kg and 118.9 +/- 22.9 kg, P < 0.001, respectively). Limitations included a homogenous patient population and inability to control confounding factors. Conclusion and Relevance: Improvement in glycemic control occurred despite reductions in TDD of insulin. Improvements in A1c and body weight were clinically significant. This analysis adds to existing literature supporting the use of GLP-1 RAs in patients on high daily doses of insulin.