Young Woman with Autoimmune Diabetes Stops Insulin After Starting Oral Semaglutide | Research

The takeaway

A 23-year-old woman with slowly progressive autoimmune diabetes achieved sufficient glycemic control with oral semaglutide to discontinue insulin entirely, with bonus improvements in weight and eating behavior.

Insulin discontinued
Despite having autoimmune diabetes, the patient's blood sugar control improved enough on oral semaglutide to stop insulin injections — an unusual outcome in a condition typically requiring lifelong insulin.

What the researchers found

A 23-year-old woman with slowly progressive type 1 diabetes (SPIDDM) who had poor blood sugar and weight control on insulin, dapagliflozin, and metformin achieved significant improvements after adding oral semaglutide. Her glycemic control improved enough to discontinue insulin entirely, she lost weight, and her eating behaviors improved. This case suggests GLP-1 RAs could be a valuable therapeutic option for SPIDDM — a form of autoimmune diabetes where some insulin production remains.

Why it matters

GLP-1 drugs are established for type 2 diabetes but their role in autoimmune (type 1) diabetes is unclear. SPIDDM/LADA is a challenging condition where patients retain some beta-cell function but gradually lose it. This case demonstrates that a GLP-1 peptide drug can successfully replace insulin therapy in certain autoimmune diabetes patients, potentially preserving remaining beta-cell function while improving both metabolic and behavioral outcomes.

The numbers in context

n=1 · 23-year-old woman · SPIDDM since age 19 · oral semaglutide added · improved glycemic levels · weight improvement · insulin discontinued · eating behavior changes noted

How the study worked

Single case report describing the clinical management of a 23-year-old Japanese woman with probable SPIDDM. Oral semaglutide was added to an existing regimen of insulin, dapagliflozin, and metformin. Clinical outcomes including glycemic control, weight, insulin requirements, and eating behavior were documented.

Who was studied

23-year-old Japanese woman with probable slowly progressive type 1 diabetes (SPIDDM/LADA)

What this study cannot tell us

As a single case report, findings cannot be generalized. The patient had 'probable' SPIDDM — the diagnosis was not definitively confirmed. Long-term beta-cell preservation was not assessed. Whether discontinuing insulin is safe long-term in autoimmune diabetes patients on GLP-1 therapy is unknown. Eating behavior changes were observationally reported rather than systematically measured.

How to read the evidence

This is a single case report (n=1), the lowest level of clinical evidence. While the outcome is intriguing, individual case reports cannot establish efficacy or safety for a broader population. Controlled studies are needed.

When this study was published

Published in 2025, this case report reflects growing clinical interest in using GLP-1 drugs for autoimmune diabetes subtypes like SPIDDM/LADA.

The bigger picture

The boundaries between type 1 and type 2 diabetes are increasingly blurred, with conditions like SPIDDM/LADA falling in between. As GLP-1 drugs expand their indications, their potential role in autoimmune diabetes is a frontier being actively explored. This case adds to growing evidence that GLP-1 RA therapy may benefit selected type 1/LADA patients, particularly those with residual beta-cell function, by reducing insulin requirements while potentially protecting remaining insulin-producing cells.

Questions still open

Does semaglutide help preserve remaining beta-cell function in SPIDDM/LADA patients over time?
Is it safe to discontinue insulin in autoimmune diabetes patients on GLP-1 therapy, given the risk of diabetic ketoacidosis?
Would other GLP-1 RAs show similar benefits in SPIDDM, or is this specific to semaglutide?

Common questions

What is SPIDDM and how is it different from regular type 1 or type 2 diabetes?

SPIDDM (slowly progressive insulin-dependent diabetes mellitus), also called LADA, is an autoimmune form of diabetes where the immune system attacks insulin-producing beta cells — like type 1 diabetes — but much more slowly. Patients may initially be mistaken for type 2 diabetes because they retain some insulin production for years. This retained beta-cell function is what makes GLP-1 drugs potentially effective, as they can enhance the remaining insulin secretion.

Is it risky to stop insulin in someone with autoimmune diabetes?

It can be. People with autoimmune diabetes who stop insulin risk developing diabetic ketoacidosis (DKA) if their remaining beta cells fail. This case was carefully monitored, and the patient's glycemic control was sufficient without insulin. However, close medical supervision and regular monitoring of beta-cell function would be essential for anyone attempting this approach.

Read the original research

A Case of Slowly Progressive Type 1 Diabetes Mellitus (SPIDDM, Probable) Successfully Managed With Oral Semaglutide for Glycemic Control and Weight Management Accompanied by Changes in Eating Behavior.

Cureus, 17(11), e96335

View on PubMed ↗Publisher’s paper ↗

Citation

Hirai, Taro; Kitada, Munehiro; Endo, Keita; Hayashi, Koichi; Suzuki, Toshihiko. (2025). A Case of Slowly Progressive Type 1 Diabetes Mellitus (SPIDDM, Probable) Successfully Managed With Oral Semaglutide for Glycemic Control and Weight Management Accompanied by Changes in Eating Behavior.. Cureus, 17(11), e96335. https://doi.org/10.7759/cureus.96335