Combining GLP-1 Drugs with Pramlintide for Weight Loss in Type 1 Diabetes: Three Patient Cases

Three patients with type 1 diabetes and obesity achieved substantial weight loss using a combination of a GLP-1 receptor agonist and pramlintide (an amylin analog). Patient 1 lost 20.9 kg (16.1% of body weight) over 10 months on semaglutide plus pramlintide. Patient 2 lost a total of 21.2 kg (23.1% of body weight) after adding dulaglutide and pramlintide to her regimen. Patient 3 lost 14.6 kg (17.9% of body weight) over 6 months on semaglutide plus pramlintide. All three experienced no significant side effects, needed less insulin, and maintained or improved their HbA1c levels.

This is a case series describing three patients seen in clinical practice. Each patient with type 1 diabetes and obesity was prescribed a GLP-1 receptor agonist (semaglutide or dulaglutide) in combination with pramlintide. Weight, HbA1c, insulin requirements, and side effects were tracked over 6 to 10 months of treatment.

People with type 1 diabetes who also have obesity face a unique challenge: most weight loss drugs are studied in type 2 diabetes patients, leaving a significant treatment gap. This case series suggests that combining a GLP-1 drug with pramlintide may produce impressive weight loss in this underserved population without worsening blood sugar control — potentially by targeting appetite through two complementary gut-brain pathways.

The GLP-1 drug revolution has primarily focused on type 2 diabetes and general obesity. People with type 1 diabetes have largely been left out of these advances. This case series hints that combining GLP-1 agonism with amylin replacement — two natural gut-brain signaling pathways — could fill that gap. If confirmed in larger studies, it would open a new treatment avenue for a population that currently has few pharmacological options for weight management.

As a case series of only 3 patients, this provides the lowest level of clinical evidence. There was no control group, no randomization, and no blinding. Individual results may not be generalizable. The follow-up period was relatively short (6-10 months), so long-term efficacy and safety are unknown. One patient was also on topiramate, making it harder to attribute all weight loss to the peptide combination.