Glycaemic Changes After Semaglutide Discontinuation in Adults With Type 1 Diabetes Using Automated Insulin Delivery: Analysis of the ADJUST-T1D Extension Study.

In 30 seconds

This analysis of a 12-week extension to the ADJUST-T1D randomised controlled trial examined continuous glucose monitoring outcomes after semaglutide was stopped in adults with type 1 diabetes and obesity using automated insulin delivery. It compared 16 participants who had received semaglutide and discontinued it with 22 previously assigned to placebo. Time in range declined more after semaglutide discontinuation than with placebo (median change -3.6% vs. 1.5%; adjusted p = 0.044), alongside greater increases in measures of glycaemic variability. The findings suggest treatment-associated glycaemic benefits may not be fully sustained after withdrawal.

Key findings

• Time in range declined more after semaglutide discontinuation than placebo (median change -3.6% vs. 1.5%; adjusted p = 0.044).
• Glucose standard deviation increased by 6.0 vs. 1.2 mg/dL, and coefficient of variation by 3.1% vs. 1.1% (both adjusted p = 0.044).
• Time above range increased numerically, but the between-group difference was not significant after adjustment (adjusted p = 0.064).
• No significant between-group differences were observed in hypoglycaemia-related CGM metrics.

Why it matters

The results indicate that glycaemic improvements observed during semaglutide treatment may diminish after it is stopped, including through reduced time in range and greater glucose variability. This is relevant when interpreting treatment effects in adults with type 1 diabetes and obesity: outcomes during therapy may not represent glycaemic control after withdrawal. The extension also highlights the value of assessing glucose patterns beyond treatment periods.

What to keep in mind

The extension analysis included small groups (16 and 22 participants) and followed outcomes for 12 weeks after discontinuation; findings may not establish longer-term changes.