I'm very interested in this recently-published paper (link below) that details the remarkable improvements in
#type1diabetes with GLP-1 agonists (
#semaglutide;
#wegovy/
#ozempic). These drugs get a lot of attention for the improvements in
#type2diabetes, but the improvements in
#type1diabetes highlight what I believe is the main benefit in disorders of
#hyperglycemia (i.e.,
#diabetes). Many claim that the benefit of GLP-1 agonism is the insulin-secretagogue effect (i.e., they stimulate insulin release; this idea is appropriately challenged). This study removes insulin from the equation because people with T1DM don't have sufficient beta cells to make sufficient
#insulin. However, they DO have ample alpha cells producing FAR too much
#glucagon. The late Dr. Roger Unger proposed that T1DM is as much a disease of too much glucagon as it is too little insulin, and was able to correct T1DM by simply inhibiting glucagon. (As a reminder, whereas insulin seeks to lower blood glucose, glucagon seeks to raise it.) That semaglutide is able to correct glycemia in people with T1DM while lowering insulin needs is evidence, to me, that the glucagon-inhibiting effect is the primary mechanism of improving glucose in people with diabetes.
nejm.org/doi/full/10.1056/NE…