Oral Semaglutide and Basal Insulin Successfully Treat Latent Autoimmune Diabetes in Two Young Females
Background
Latent autoimmune diabetes in youth (LADY) and adults (LADA) are forms of autoimmune diabetes characterized by progressive β-cell decline, often leading to eventual insulin dependence. Diagnosing LADY/LADA can be challenging due to its slow progression, impacting timely therapeutic intervention. Current standard-of-care often involves insulin, but strategies to preserve endogenous insulin production are highly sought after. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) like semaglutide are known for their glucose-dependent insulinotropic effects and potential to improve β-cell function, making them a candidate for such preservation.
Study Design
This case series describes the treatment of two young female patients diagnosed with LADY. Case 1, a 20-year-old woman with obesity (31.8 kg/m2), initially received metformin and basal insulin. Due to high-titer autoantibodies and detectable C-peptide, metformin was stopped, and oral semaglutide was initiated. Case 2, a 13-year-old girl with autoimmune diabetes, was initially on multiple daily insulin injections (MDI). After almost 2 years, with detectable C-peptide, meal-time insulin was stopped, and oral semaglutide was started. Both patients continued basal insulin.
Results
Both patients demonstrated positive outcomes with the combined oral semaglutide and basal insulin regimen. In Case 1, after 12 months on oral semaglutide, the patient maintained detectable C-peptide levels, experienced significant weight loss of -20 kg, and showed resolution of liver steatosis. Case 2, after 15 months of follow-up on oral semaglutide, achieved optimal glycemic control and exhibited increased C-peptide levels.
This is the first case series to highlight the potential of oral semaglutide and basal insulin in treating LADY, yielding optimal glycometabolic outcomes. The treatment also provided beneficial effects on weight control and non-confirmed improvements in metabolic dysfunction-associated steatotic liver disease (
MASLD).
Key Findings
- Oral semaglutide combined with basal insulin achieved optimal glycemic control in two young female LADY patients.
- C-peptide levels remained detectable or increased in both patients, suggesting preservation of endogenous insulin production.
- A 20-year-old patient experienced significant weight loss of -20 kg and resolution of liver steatosis after 12 months.
- A 13-year-old patient achieved optimal glycemic control and increased C-peptide levels after 15 months.
Why It Matters
This case series suggests that oral semaglutide could be a valuable addition to the treatment of LADY, potentially delaying or reducing the need for full insulin dependence. For peptide users and clinicians, this highlights an insulin-sparing strategy that not only improves glycemic control but also offers significant benefits in weight management and potentially liver health. While a case series, it provides early evidence for a novel protocol in a challenging patient population, suggesting that GLP-1RAs might preserve β-cell function in autoimmune diabetes. Further research is needed, but this opens avenues for exploring oral semaglutide in similar contexts.
semaglutide
latent-autoimmune-diabetes
lady
lada
glp-1-agonist
case-series