Combined GLP1 Agonist and Amylin Analogue for Severe Obesity in a Patient with Type 1 DM

Background: Glucagon-like peptide 1 agonists (GLP1a) have been reported in literature to benefit Type 1 Diabetes patients with obe- sity, though they have been heavily studied in patients with Type 2 Diabetes. In addition, amylin analogues have been noted to exert an- orexiogenic effect in patients with diabetes and are FDA approved in both Type 1 and Type 2 Diabetes. The combination GLP1a and amylin analogue has not yet been studied in Type 1 Diabetes population with severe obesity. Hence, we describe a case of a patient with Type 1 Diabetes on an insulin pump with poor glycemic control and severe obesity prescribed semaglutide in combination with an amylin analog. Methods: Retrospective case report of the electronic health record. Results: A 32-year-old male with T1D on insulin pump therapy, obe- sity (weight 285lbs (129.3 kg); BMI of 47.4 kg/m2; Class 3b) and rest- less leg syndrome struggled with weight since early childhood, with worsening progression to adult obesity. He was a non-responder to several weight-loss attempts in the past including the use of FDA ap- proved anti-obesity medication in conjunction with intensive lifestyle modification (AOM; phentermine, high protein and low carb diet). Anthroprometric and metabolic assessment showed central abdom- inal adiposity, elevated fasting glucose and A1C 8.3%. Therapy was initiated using a GLP1 agonist (semaglutide titrated up to 1.0mg SC) in combination with pramlintide 15mcg pre-meals. At 6 months, BMI decreased to 40.9 kg/m2 (-13.7% BMI reduction from baseline) with a total -40lbs (18.2 kg; -14% total body weight loss; repeat A1c 6.8%) since initial visit. The patient continues to meet clinical criteria for metabolic bariatric surgery and might consider in the future. Conclusions: Combination incretin therapy has a promising role in the both the treatment of Type 2 Diabetes and Type 1 Diabetes, though literature is sparse regarding its role in Type 1 Diabetes. The role of novel incretin combination with amylin analog therapies needs to be explored further in the context of patients with Type 1 Diabetes.