Semaglutide Use With Automated Insulin Delivery in Adults With Type 1 Diabetes: Qualitative Analyses and Patient-reported Outcomes From a Randomized Controlled Trial

Interest in incretin therapy for type 1 diabetes is increasing, but data are lacking regarding patient-reported outcomes and personal experience among those using this drug.

This work is an analysis from a double-blind, randomized, crossover trial assessing semaglutide vs placebo, with automated insulin delivery in adults with type 1 diabetes, after 15-week interventions. The following questionnaires were used after each intervention: the Diabetes Distress Scale; the Hypoglycemia Fear Survey; the Diabetes Treatment Satisfaction Questionnaire; Insulin-delivery Systems: Perceptions, Ideas, Reflections and Expectations (INSPIRE); and the Diabetes Bowel Symptom Questionnaire (DBSQ). Semistructured interviews were performed at the end of the trial. Interviews were recorded, transcribed, and coded by research personnel for themes using an inductive-deductive approach.

Twenty-three participants completed their questionnaires, whereas 24 performed interviews. For semaglutide vs placebo, only the DBSQ showed differing scores with increased symptom frequency and severity with semaglutide. Within the interviews, 42% of patients expressed interest in semaglutide use outside the study, with their reasons being lower insulin requirements, weight loss, and improved glycemic management. Many of these qualities, including complication risk reduction, were qualities of the ideal adjunctive therapy as per participants. Nausea and fear of vomiting were barriers to accurate preprandial determination of upcoming carbohydrate intake and thus preprandial bolus. Synergy was noted between the drug and automated insulin delivery by the participants.

Semaglutide is of interest to those with type 1 diabetes. Safe and accurate bolus practice by patients in the context of nausea should be reviewed during dose titration. Questionnaires did not capture differences between semaglutide and placebo outside of increased gastrointestinal side effects.