Semaglutide use was associated with rapid and sustained declines in insulin requirements among adults with type 1 diabetes managed on insulin pump therapy. Findings from this post-hoc analysis, published in Diabetes, Obesity and Metabolism, offer new insights into optimizing insulin dosing when integrating glucagon-like peptide-1 (GLP-1) receptor agonists with pump-based care.

The analysis included 26 participants from a double-blind, randomized, crossover trial comparing semaglutide (up to 1 mg) with placebo during automated insulin delivery (AID). Over 11 weeks of routine pump use with continuous glucose monitoring (CGM), changes in insulin dosing, carbohydrate intake, and pump parameters were evaluated.

By day 7, total and bolus insulin doses declined significantly, paralleling reduced carbohydrate intake. Basal insulin decreased by day 32. At day 77, carbohydrate ratios increased by 4.1%, correction factors by 11.2%, and programmed basal rates fell by 7.9%. Time spent in hypoglycemia remained below 4% throughout follow-up.

These results show that semaglutide decreases insulin demand primarily through lower bolus needs from reduced carbohydrate consumption. Although diabetes technology supports safety, active adjustment of pump settings remains critical to sustain optimal glycemic control.