Improved Glycemic Control using Oral Semaglutide in a Patient with Type 2 Diabetes with Insulin Allergy

Abstract

We present a unique clinical scenario of a patient with type 2 diabetes mellitus (T2DM) who exhibited an allergic reaction to all forms of insulin. The patient had previously maintained good glycemic control with maximum-dose metformin. However, her glycemic control deteriorated once she became pregnant. Trials with various types of insulin resulted in allergic reactions, but this was managed successfully using insulin pump therapy, which was discontinued postpartum. Upon reassessment, her HbA1c had deteriorated to 80 mmol/mol. After re-attempting various insulin formulations without success, she was trialed again using the closed-loop Omnipod system. Initial management with the closed-loop system failed to achieve optimal glycemic control. Therefore, oral semaglutide was added. The introduction of oral semaglutide to her treatment regimen led to a significant improvement in her glycemic status. This report compares the patient's glycemic control while on the closed-loop Omnipod system alone versus in combination with oral semaglutide. The findings suggest that oral semaglutide, in conjunction with a closed-loop system, may offer a viable alternative for patients with insulin-dependent type 2 diabetes who cannot tolerate insulin.

Keywords

insulin allergy - semaglutide - GLP-1 - insulin pump

Statement of Patient Consent

The authors confirm that they have obtained an informed consent from the patients for the anonymous reporting of their data.

Authors' Contribution

All the authors drafted and/or critically revised the manuscript. K.A. treated the patient in the clinic and gathered the data, while M.G. performed the literature review. All the authors read and approved the final manuscript.

Compliance with Ethical Principles and Statement

At our institution, no prior ethical approval is required for single-case reports or small case series, provided the patients provide informed consent. The tenets of the Helsinki declaration were followed throughout.

Publikationsverlauf

Artikel online veröffentlicht:
17. September 2024

• References

• 1 Radermecker RP, Scheen AJ. Allergy reactions to insulin: effects of continuous subcutaneous insulin infusion and insulin analogues. Diabetes Metab Res Rev 2007; 23 (05) 348-355
• 2 Haastrup MB, Henriksen JE, Mortz CG, Bindslev-Jensen C. Insulin allergy can be successfully managed by a systematic approach. Clin Transl Allergy 2018; 8: 35
• 3 Pföhler C, Müller CS, Hasselmann DO, Tilgen W. Successful desensitization with human insulin in a patient with an insulin allergy and hypersensitivity to protamine: a case report. J Med Case Rep 2008; 2: 283
• 4 Pickup JC, Sutton AJ. Severe hypoglycaemia and glycaemic control in Type 1 diabetes: meta-analysis of multiple daily insulin injections compared with continuous subcutaneous insulin infusion. Diabet Med 2008; 25 (07) 765-774
• 5 Niman S, Hardy J, Goldfaden RF. et al. A review on the efficacy and safety of oral semaglutide. Drugs R D 2021; 21 (02) 133-148
• 6 Wang S, Wang S, Wang Y, Luan J. Glycemic control, weight management, cardiovascular safety, and cost-effectiveness of semaglutide for patients with type 2 diabetes mellitus: a rapid review and meta-analysis of real-world studies. Diabetes Ther 2024; 15 (02) 497-519