For the first time, the American Diabetes Association's 2026 Standards of Care recommends that adults with type 1 diabetes and obesity be considered for GLP-1 receptor agonist therapy. The threshold is a body mass index of 30 or higher, or 27.5 for Asian American adults.
The new recommendation, numbered 8.29, applies to the drug class behind Ozempic, Wegovy, Mounjaro and Zepbound. It closes a gap that had long frustrated patients and clinicians in type 1 diabetes.
The condition was excluded from earlier GLP-1 obesity guidance because of concerns about severe low blood sugar and diabetic ketoacidosis, a life-threatening state in which the body burns fat too fast when insulin is scarce.
What the trial evidence shows
A 26-week randomized trial published in NEJM Evidence in June 2025 assigned 72 adults with type 1 diabetes and a BMI of 30 or higher, all using automated insulin delivery, to weekly semaglutide up to 1 mg or placebo.
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In the semaglutide group, 36 percent hit a combined target of good glucose time-in-range, low hypoglycemia, and at least 5 percent weight loss. In the placebo group, no one did.
Weight fell about 8.8 kilograms more with semaglutide than with placebo, and no diabetic ketoacidosis was reported in either arm.
"Semaglutide helped more people reach their blood sugar and weight goals without decreasing blood sugar," said Andrew Ahmann, M.D., an emeritus professor of medicine at Oregon Health & Science University School of Medicine and a co-author of the trial.
Real-world data point the same way. A 12-month study of 250 people with type 1 diabetes and obesity, published in Diabetes, Obesity and Metabolism in 2026, tracked three GLP-1 drugs against usual care.
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Average weight loss reached 10.9 percent on tirzepatide, the active ingredient in Eli Lilly's Mounjaro and Zepbound, 9.9 percent on semaglutide, the active ingredient in Novo Nordisk's Ozempic and Wegovy, and 7.1 percent on liraglutide.
HbA1c fell modestly in all three groups, and the authors reported no severe hypoglycemia or diabetic ketoacidosis over the year.
Why the safeguards still matter
The ADA is not endorsing GLP-1 drugs as a substitute for insulin. Type 1 diabetes means the pancreas makes little or no insulin, so injections remain essential.
Semaglutide and tirzepatide were designed for type 2 diabetes and obesity, where the body still produces insulin but responds to it poorly. In type 1 diabetes, the GLP-1 drug is added on top of insulin.
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Starting one typically requires reducing insulin doses to avoid hypoglycemia, using continuous glucose monitoring, and educating patients about the warning signs of ketoacidosis.
The ADA frames the choice as a shared decision between patient and clinician. Its 2026 guidance flags people with a history of eating disorders, frequent ketoacidosis or highly sensitive insulin responses as needing extra caution.
Adults with type 1 diabetes and a BMI at or above 30 who want to explore a GLP-1 drug can now bring the 2026 ADA recommendation to their endocrinologist, and expect a plan that includes insulin adjustment and continuous glucose monitoring before the first dose.
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This article is made and published by Jesper Bengtson, who may have used AI in the preparation.