GLP-1 receptor agonists — including Ozempic, Wegovy (semaglutide), Mounjaro, and Zepbound (tirzepatide) — were developed to treat type 2 diabetes and, more recently, chronic weight management. They help regulate blood sugar, improve insulin efficiency, slow digestion, and increase feelings of fullness. While not FDA-approved for type 1 diabetes (T1D), a growing number of people in the community are using them off-label to smooth out glucose levels, reduce post-meal spikes, and cut their total daily insulin needs.

For those curious about the science behind these drugs, you can watch the below video— but in short, their ability to slow gastric emptying and improve insulin sensitivity makes them appealing for T1Ds looking for more stable control. Early reports from users point to better time-in-range, fewer extreme highs and lows, and in some cases, moderate weight loss.

The largest evidence to date comes from the Adjust-T1D trial, presented at this year’s American Diabetes Association Scientific Sessions. The randomized controlled study followed people with T1D and obesity and found lower A1C, reduced basal and bolus insulin use, fewer glucose spikes, and moderate weight loss — without increasing severe hypoglycemia or diabetic ketoacidosis (DKA). A meta-analysis of 13 smaller studies in overweight or obese T1Ds produced similar findings, strengthening the case for broader research.

That research is now underway with Eli Lilly’s phase 3 trial, launched in April 2025, which lowered the BMI threshold to 25, allowing more people with type 1 diabetes to qualify. Over the next two years, researchers will track A1C, time-in-range, insulin use, and weight changes to see if results warrant FDA approval — a key step toward insurance coverage.

Right now, coverage is the biggest roadblock. Without an on-label indication for T1D, GLP-1s remain costly and out of reach for most. Some people qualify through other diagnoses like type 2 diabetes, obesity, or cardiovascular risk, while others self-pay or turn to compounding pharmacies. Advocates argue that access could improve outcomes for many with type 1, but it will take both stronger clinical evidence and policy changes to make it a reality.

In our latest Diabetech podcast, I spoke with longtime diabetes advocate and healthcare executive Marie Schiller about the real-world use of GLP-1s in T1D, the latest research findings, and possible pathways to coverage. We also discuss her personal experience with these medications and what the future of multi-drug treatment for type 1 might look like. You can listen at the top of this page or watch the video conversation below.

Disclaimer: Diabetech content is not medical advice—it’s for educational purposes only. Always consult with a physician before making changes to your healthcare.