{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T21:59:32Z","timestamp":1791323972595,"version":"4.3.1"},"reference-count":19,"publisher":"American Diabetes Association","issue":"5","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"name":"Breakthrough T1D"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>In this post hoc analysis, we used the data from the Adjunct Semaglutide Treatment in Type 1 Diabetes (ADJUST-T1D) trial, a double-blind, multicenter, randomized, placebo-controlled trial of semaglutide 1 mg\/week in adults with type 1 diabetes (T1D) and obesity, to evaluate the relationship between insulin dose reduction and weight loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>Changes between semaglutide and placebo groups over 26 weeks in total daily insulin dose (TDD), basal and bolus insulin doses, carbohydrate intake, and user-initiated bolus counts were analyzed using linear mixed models. Mediation analysis was used to attribute direct effects of semaglutide versus weight loss on insulin dose reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>From baseline to week 26, there was a significant 22.6% reduction in TDD (95% CI \u221228.3 to \u221217.0), which was driven by greater reductions in bolus insulin (\u221230.5%; 95% CI \u221239.5 to \u221221.5) than basal insulin (\u221215.6%; 95% CI \u221221.5 to \u22129.7). The basal-to-TDD ratio increased from 0.56 to 0.62 (P &amp;lt; 0.001) and insulin dose (in units\/kg\/day) decreased from 0.72 to 0.60 (P &amp;lt; 0.001) in the semaglutide group. At week 4, an 83% (\u221211.1 units\/day) reduction in TDD was due to a direct drug effect, and 17% (\u22122.3 units\/day) was attributed to weight loss, whereas at week 26, the difference was split evenly between direct effect (\u221211.4 units\/day; 52%) and weight loss (\u221210.5 units\/day; 48%). Daily carbohydrate intake decreased from 137 g (95% CI 107\u2013167) at baseline to 107 g (95% CI 76\u2013137) at 26 weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Semaglutide produced rapid, sustained, and primarily bolus-driven insulin dose reductions, with early effects being largely independent of weight loss in adults with T1D and obesity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc25-2249","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T21:25:11Z","timestamp":1766438711000},"page":"718-723","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":10,"title":["Effect of Semaglutide on Insulin Dose Reduction in Adults With Type 1 Diabetes and Obesity Using Automated Insulin Delivery Systems: ADJUST-T1D Post Hoc Analysis"],"prefix":"10.2337","volume":"49","author":[{"given":"Kagan E.","family":"Karakus","sequence":"first","affiliation":[{"name":"Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus 1 , Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4518-5179","authenticated-orcid":false,"given":"Halis K.","family":"Akturk","sequence":"additional","affiliation":[{"name":"Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus 1 , Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davida","family":"Kruger","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes, and Bone and Mineral Disease, Henry Ford Health 2 , Detroit, MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4544-5404","authenticated-orcid":false,"given":"Andrew","family":"Ahmann","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University 3 , Portland, OR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anuj","family":"Bharvaga","sequence":"additional","affiliation":[{"name":"Iowa Diabetes Research 4 , West Des Moines, IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine R.","family":"Langel","sequence":"additional","affiliation":[{"name":"Iowa Diabetes Research 4 , West Des Moines, IA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney A.","family":"Ackeifi","sequence":"additional","affiliation":[{"name":"Breakthrough T1D 5 , New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Rosen","sequence":"additional","affiliation":[{"name":"Breakthrough T1D 5 , New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5577-8221","authenticated-orcid":false,"given":"Laura","family":"Pyle","sequence":"additional","affiliation":[{"name":"Division of Metabolism, Endocrinology and Nutrition, School of Medicine, University of Washington 6 , Seattle, WA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9337-3740","authenticated-orcid":false,"given":"Janet K.","family":"Snell-Bergeon","sequence":"additional","affiliation":[{"name":"Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus 1 , Aurora, CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3827-7107","authenticated-orcid":false,"given":"Viral N.","family":"Shah","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Metabolism, Indiana University School of Medicine 7 , Indianapolis, IN"},{"name":"Center for Diabetes and Metabolic Diseases, Indiana University School of Medicine 8 , Indianapolis, IN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"2026061812472346800_B1","doi-asserted-by":"crossref","first-page":"EVIDoa2500173","DOI":"10.1056\/EVIDoa2500173","article-title":"Semaglutide in adults with type 1 diabetes and obesity","volume":"4","author":"Shah","year":"2025","journal-title":"NEJM Evid"},{"key":"2026061812472346800_B2","doi-asserted-by":"crossref","first-page":"1702","DOI":"10.2337\/dc16-0691","article-title":"Efficacy and safety of liraglutide added to insulin treatment in type 1 diabetes: the ADJUNCT ONE treat-to-target randomized 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