Some of my followers may recall that once upon a time, there was a diabetes blog started by Amy Tenderich which was called "Diabetes Mine" and it described itself as "a gold mine of straight talk and encouragement for people touched by diabetes. We offer a unique mix of the latest diabetes news, views, and reviews. We also act as a strong voice of patient advocacy, working to foster innovation in diabetes care."
Amy subsequently hired people to manage the content published on the diabetes blog she had started, hence it was run by people who were paid to report on topics relevant to people diabetes, and all of the authors all had diabetes themselves so they shared that perspective which so few publications share (most articles about diabetes are written by people who have no clue what is important to people with diabetes, yet they assert things to be the biggest new improvement when those news items are rarely big or even improvements. But Amy decided to sell the Diabetes Mine blog to an entity known as Healthline back in 2015, which continued publishing and updating it until 2022, at which point, Healthline decided to discontinue updates to Diabetes Mine. No updates have been made to Diabetes Mine since that time.
The decision to discontinue publishing on Diabetes Mine was made in early 2022, with the closure taking effect in April 2022 after 17 years online, according to DiabetesMine.com's Facebook page. Amy Tenderich, the founder of Diabetes Mine, is now focusing on the Diabetes Mine Innovation Project, while Mike Hoskins was to remain with Healthline's broader editorial team.
Anyway, Amy Tenderich continued something she calls the Diabetes Mine Innovation Project https://ddataexchange.com/ if episodically. Earlier in 2025, the Diabetes Mine Innovation Project conducted a nationwide survey of nearly 200 people (technically, 186 respondents) living with Type 1 diabetes to better understand real-world use of GLP-1 receptor agonists (referred to as GLP-1 therapies henceforth) GLP-1 therapies. From access challenges to clinical outcomes, the findings highlight how patients are currently navigating off-label use — and what's working (or not) in daily life. That study has been published at https://drive.google.com/file/d/1WD5LCh07-fbCKR1t3tdjkaojJiG1Zb3W/
The findings, while interesting, remain fairly limited.
The biggest limitation is that it was a survey conducted using a non-scientific "convenience" sample rather than a truly representative sample of adults with T1D, which means that the survey findings may help researchers to better understand off-label usage of GLP-1s among patients with T1D, but they are not truly representative of anything other than the opinions of a few people who answered the survey questions. Right now, there is little quantitative data on T1D GLP-1 usage.
There is also another limitation: the survey itself: it refers to GLP-1s generically, without specifying any particular brand or version of GLP-1 treatment. Novo Nordisk previously tried unsuccessfully to attain FDA "label extensions" on its GLP-1s, but the FDA denied those attempts as little more than an effort to sell the expensive products to a larger audience. Most "studies" have involved only the newest, patent-protected and overpriced GLP-1 treatments, rather than generics.
But, since 2024, the FDA has approved three generics of liraglutide, and even more generics of that product (and others, does anyone remember Lilly's Trulicity?) are currently pending FDA approval decisions. With each new generic that hits the market, prices on all of the others tend to fall even further. The advent of cheaper generics should assuredly be explored, in part, not only because the branded GLP-1 treatments are expensive, but their biggest innovation is they are extended-release products, while generics are dosed daily. But daily dosage offers T1D patients a major advantage of being able to adjust therapy daily based on how glucose levels are impacted. With the newest GLP-1s, patients can only adjust insulin because the GLP-1 lasts all week. That is a limitation of the GLP-1 treatment being commercialized. But generics are readily available now and cost vastly less money.
Key Reasons for Previous FDA Denial or Lack of Label Expansion on GLP-1 Products such as Victoza (liraglutide) in T1D:
- Mechanistic Limitations: GLP-1 agonists help to stimulate insulin secretion from functioning beta cells. In autoimmune T1D, complete beta-cell destruction limits this mechanism, thereby making GLP-1s less effective as a monotherapy. However, the Type 2 studies which were combined with insulin were not a basal/bolus regimen, but were conducted on GLP-1s with basal-only insulin which is unheard of in Type 1 diabetes. A well-designed study should be a GLP-1 with a basal/bolus regimen but never with basal-only insulin.
Safety Concerns:
- Increased risk of hypoglycemia when used adjunctively with insulin.
- Gastrointestinal side effects (e.g., nausea, vomiting) may complicate glucose management in T1D.
- Insufficient Efficacy Data:
- Trials have shown modest improvements in weight and insulin dose reduction, but not enough to justify label expansion.
- No consistent evidence of improved glycemic control or reduced complications in T1D populations.
Regulatory Caution:
- The FDA has emphasized the need for far more robust, T1D-specific Phase III data before it would even consider label changes and Novo Nordisk did not want to undertake separate studies on T1D, merely as a leg of a study for T2D and/or obesity. As a result, Novo Nordisk has not submitted a formal supplemental Biologics License Application (sBLA) for its GLP-1s in T1D.
The thinking at the company was that it was already having severe difficulty keeping up with demand among the obese populations without any form of diabetes, so the company never bothered (although it could). That opens an opportunity for peer-reviewed studies not designed by the drug manufacturer which are much more objective (and less tainted by the sponsor company) in nature aiming to sell more of a particular treatment, including those which study different GLP-1 therapies including generic GLP-1 products such as liraglutide from Teva, Hikma or Meitheal Pharmaceuticals, respectively. Academic reseach would appear to be the best vehicle to undertake such objective research.
While the Diabetes Mine Innovation Project study does answer some important, unanswered questions, much more robust and well-designed research is clearly needed. So far, however, these are not on generic GLP-1 products, only the newest, most expensive new GLP-1 therapies. But generics offer an advantage in that they are not extended-release products, enabling more adjustment by the patients either on the GLP-1 or the accompanying insulin dosages.
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