Exploring a Synergistic Approach: Dual GLP-1 Agonist Combined with Degludec Basal Insulin for Early Type 1 Diabetes Treatment and its Impact on Albumin-Insulin Producing Cells Expression."

This manuscript explores various aspects related to the use of dual GLP-1 agonist with degludec basal insulin as a potential treatment approach for early type 1 diabetes. The background section highlights the destruction of beta cells in type 1 diabetes and the emergence of GLP-1 agonists as a promising option for managing obesity and type 2 diabetes. The authors discuss a retrospective analysis of the efficacy of semaglutide, a GLP-1 agonist, in patients with newly diagnosed type 1 diabetes. The results show the elimination of prandial and basal insulin, increased C-peptide levels, and improved glycemic control. However, the study's retrospective nature and lack of a control group emphasize the need for larger prospective trials. The interpretation section highlights the potential of GLP-1 agonists in protecting residual beta cells, stimulating cell proliferation, and reprogramming liver cells into insulin-producing cells. Moreover, modifying GLP-1 agonists with albumin ligands shows promise in extending their half-life and enhancing their anti-diabetic effects. The perspective section provides a comprehensive overview of the synergistic approach, considering the pharmacokinetic properties of degludec, the plasticity of adult human hepatic tissue, and the benefits of modified GLP-1 derivatives. The conclusion emphasizes the need for further research to explore the full potential of this approach in type 1 diabetes treatment. The proposed approach offers a promising avenue for the treatment of type 1 diabetes, integrating the autoimmune hypothesis, the proliferative effects of GLP-1, and modifications using albumin ligands. By combining these elements, we can strive towards restoring beta cell mass and function, ultimately improving the lives of individuals living with type 1 diabetes. The manuscript is planned to undergo clinical trials in 2024, registered as 'Amr Ahmed, Maher M. Akl, Semaglutide GLP1 Agonists with Degludec Basal-bolus Insulin in Early Type 1 Diabetes to Basal-bolus' with ClinicalTrials.gov Identifier NCT06057077.