Patient-Reported Adverse Events with Adjunctive Tirzepatide or Semaglutide Treatment in Adults with Type 1 Diabetes

Adjunctive use of tirzepatide or semaglutide has demonstrated benefits in improving glucose control (HbA1c, Time in Range), reducing body weight, and insulin requirements, in overweight (OW) or obese (OB) adults with type 1 diabetes (T1D). However, the adverse event (AE) profiles with these agents in this population have not been documented. This study evaluated real-world AEs associated with tirzepatide or semaglutide use in OW/OB adults with T1D.

In this single-center study at the Barbara Davis Center for Diabetes, we surveyed 230 adults with T1D who were using tirzepatide or semaglutide as adjunctive therapies. Demographics, data for diabetes control metrics, details of tirzepatide or semaglutide use, and related AEs were collected.

Male participants had a higher baseline mean body weight (107.8 ± 18.9 kg vs. 89.6 ± 19.2 kg, P < 0.01) and were older (44.2 ± 12.2 years vs. 40.4 ± 11.5 years, P < 0.05) compared to female participants using tirzepatide or semaglutide at the time of initiation. Symptomatic hypoglycemia was more frequent in the tirzepatide-treated group compared to the semaglutide-treated group (29% vs. 13.4%, P < 0.001). Gastrointestinal AEs did not differ between the two groups. Young adults and females were more likely to report gastrointestinal AEs regardless of the medication. The proportion of individuals who reduced their dose due to AEs was similar.

We conclude that symptomatic hypoglycemia was more commonly reported by the tirzepatide-treated group compared to the semaglutide-treated group, while gastrointestinal AEs were comparable between groups. We recommend that individualized risk assessment and close supervision on insulin dose changes are required when prescribing off-label tirzepatide or semaglutide in adults with T1D.