Can you please summarize available data for use of Ozempic in patients with LADA (Latent Autoimmune Diabetes in Adults)?

Can you please summarize available data for use of Ozempic in patients with LADA (Latent Autoimmune Diabetes in Adults)?

Comment by InpharmD Researcher

Available evidence suggests that semaglutide may provide potential benefits in patients with Latent Autoimmune Diabetes in Adults (LADA), including possible preservation of beta-cell function. However, the evidence base is small and consists primarily of case reports, which generally describe improved glycemic control, substantial weight loss, and continued beta-cell function, with semaglutide often used as an adjunct to insulin and both oral and subcutaneous formulations reported. One small retrospective study also reported reductions in HbA1c, body mass index, and total daily insulin requirements, along with increased C-peptide levels. While findings are promising, larger well-designed studies are needed to establish the efficacy and safety of semaglutide in LADA, where its use remains off-label.

Background

Several recent reviews examined the safety and efficacy of semaglutide use patients with Latent Autoimmune Diabetes in Adults (LADA). The reviews identified limited evidence on semaglutide use in LADA, consisting primarily of case reports, frequently referencing one case report by Da Porto et al. (Table 2). In the case report, after the patient was diagnosed with LADA, the patient was initially started on metformin and basal insulin, which progressively normalized their blood glucose levels within the first 5 weeks of therapy; however, due to episodes of fasting hypoglycemia, the basal insulin was replaced with once-weekly subcutaneous semaglutide titrated to effect. The patient maintained good glycemic control and demonstrated a preserved beta-cell function up to 60 months after their initial diagnosis. Another case report by Lunati et al. similarly described sustained metabolic control with semaglutide in a patient with LADA and multiple autoimmune comorbidities, without requiring insulin for over 5 years (Table 3). While the reviews highlighted the potential benefits of semaglutide in LADA, including glycemic control, weight loss, and, in some cases, preservation or improvement of beta-cell function, strong evidence remains scarce, and larger randomized controlled trials are needed to establish its safety and efficacy in this population. [1], [2], [3]

Literature Review

A search of the published medical literature revealed 4 studies investigating the researchable question:

Can you please summarize available data for use of Ozempic in patients with LADA (Latent Autoimmune Diabetes in Adults)?

Level of evidence

D - Case reports or unreliable data Read more→

Please see Tables 1-4 for your response.

The Use of Semaglutide as an Add-on Therapy in Patients with Latent Autoimmune Diabetes in Adults
Design	Retrospective study N= 80
Objective	To analyze the efficacy of semaglutide use in patients affected by Latent Autoimmune Diabetes in Adults (LADA)
Study Groups	Continued semaglutide (n= 68) Discontiued semaglutide (n= 12)
Inclusion Criteria	Patients with a confirmed diagnosis of LADA per the Immunology for Diabetes Society criteria (>30 years; positive autoantibodies to islet β cells; insulin independence for at least 6 months after initial diagnosis), who received semaglutide based on independent clinical choice
Exclusion Criteria	Not explicitly stated
Methods	Data of patients with LADA treated with semaglutide, either oral or subcutaneous, as an add-on therapy to insulin were collected and analyzed. Laboratory and clinical parameters and metrics from continuous glucose monitoring were collected where available. Semaglutide was administered at an initial dose of 0.25 mg/week subcutaneously or 3 mg/day orally, with titration to a mean dose of 0.80 mg/week or 9.2 mg/day respectively.
Duration	6-month follow-up from diagnosis
Outcome Measures	Primary: Reduction in glycated hemoglobin, body mass index, and insulin total daily dose (TDD) Secondary: Increase in serum C-peptide levels and time-in-range values
Baseline Characteristics		Continued semaglutide (n= 68, analyzed)
	Age, years	47.8 ± 1.5
	Female	37
	Duration of disease, years	8.8 ± 0.9
	HbA1c, %	8.3 ± 0.2
	FPG, mg/dL	163.7 ± 15.2
	C-peptide, nmol/L	0.5 ± 0.1
	S-creatinine, mg/dL	0.88 ± 0.03
	LDL-cholesterol, mg/dL	93.4 ± 5.3
	BMI, kg/m²	26.9 ± 0.3
	Normal weight	50.1%
	Overweight	29.4%
	Obesity	20.5%
	Class 1	10.3
	Class 2	2.9
	Class 3	7.3
	Albumin-creatinine ratio, mg/gr	25.9 ± 11.8
	Micro-albuminuria (mg/L)	17.6 ± 1.8
	Positive autoantibodies GAD ZnT8 ICA IA2 Insulin Single Double Triple or more	95.4% 35.3% 60.5% 55.3% 27.8% 44.4% 22.2% 12.7%
	Abbreviations: 1A2= insulinoma-associated protein 2 autoantibody. BMI= body mass index. FPG= fasting plasma glucose. GAD= glutamic acid decarboxylase. HbA1c= glycated hemoglobin. ICA= islet cell antibody. LDL-C= low-density lipoprotein cholesterol. ZnT8= zinc transporter 8 autoantibody.
Results		Continued semaglutide (n= 68)
		Baseline	Follow-up	p-value
	HbA1c, mmol/mol	66.9 ± 2.4	52.4 ± 1.07	0.001
	HbA1c, %	8.2 ± 0.2	6.9 ± 0.1	-
	BMI, kg/m²	26.9 ± 0.8	25.5 ± 0.7	0.004
	TDD, IU/day	42.4 ± 3.3	32.4 ± 3.2	0.000
	C-peptide, nmol/L	0.5 ± 0.1	0.73 ± 0.1	0.05
	TIR, %	74.4 ± 2.6	78.9 ± 2.3	0.006
	TAR,%	22.3 ± 2.6	17.5 ± 2.1	0.003
	TBR, %	3.0 ± 1.0	2.4 ± 0.9	Ns
	Abbreviations: BMI= body mass index. HbA1c= glycated hemoglobin. TAR= time above range. TBR= time below range. TDD= total daily dose. TIR= time in range.
Adverse Events	A total of 12/80 patients discontinued semaglutide. The main reasons for discontinuation of therapy were gastrointestinal side effects, including nausea, vomiting, significant loss of appetite, diarrhea, constipation, abdominal pain, and acid reflux.
Study Author Conclusions	Semaglutide as an add-on treatment to insulin exerted relevant clinical beneficial effects on the glycometabolic control in patients with LADA. These effects are enhanced in those patients with preserved β-cell function.
Critique	The study provides valuable insights into the use of semaglutide in LADA patients, showing significant improvements in glycometabolic control. However, the retrospective design and small sample size limit the generalizability of the findings. The lack of a control group and the short follow-up duration are additional limitations. The use of different semaglutide formulations and dosages could also introduce variability in the results.

Table 1 References:
[4] Lunati ME, Cimino V, Bernasconi D, et al. The use of semaglutide as an add-on therapy in patients with latent autoimmune diabetes in adults. J Clin Endocrinol Metab. 2026;111(7):1842-1849. doi:10.1210/clinem/dgag072

Semaglutide Treatment in Adult-Onset Autoimmune Diabetes: A Case Study With Long-Term Follow-Up and Periodic Evaluation of Beta-Cell Function
Design	Case report
Case presentation	A 36-year-old woman with autoimmune thyroiditis and a history of diet-controlled gestational diabetes 5 years earlier presented with polyuria, recurrent genital infections, and recent unintentional weight loss despite an active lifestyle. She had a lean body mass index (BMI) of 20 kg/m² and marked hyperglycemia with a glucose of 315 mg/dL and glycated hemoglobin (HbA1c) of 12.3% without ketosis. Given her young age, lean habitus, active lifestyle, and weight loss, autoimmune testing showed positive GAD and IA-2 antibodies with preserved fasting C-peptide of 0.65 ng/mL, confirming Latent Autoimmune Diabetes in Adults (LADA). She was initially treated with metformin 1000 mg orally twice daily and basal insulin (as insulin glargine 10 units subcutaneously daily), but within 5 weeks, her glucose levels normalized and she developed fasting hypoglycemia despite very low insulin doses. Insulin was therefore discontinued, and semaglutide 0.25 mg/week was initiated and increased to 0.5 mg/week after 4 weeks. Over 5 years of follow-up, she maintained good glycemic control. At 36 months, her HbA1c increased mildly to 7.1%, prompting an increase in semaglutide to 1 mg/week. Serial mixed-meal tolerance tests at 12, 24, 36, 48, and 60 months demonstrated preserved beta-cell function through 5 years.
Study Author Conclusions	This report exposed an interesting case showing the effectiveness of early treatment with a glucagon-like peptide receptor agonist (semaglutide) in maintaining long-term good glycemic control and associated with the preservation of beta-cell function over a five-year observation period in a young woman with LADA.

Table 2 References:
[5] Da Porto A, Varisco E, Antonello M, Casarsa V, Sechi LA. Semaglutide Treatment in Adult-Onset Autoimmune Diabetes: A Case Study With Long-Term Follow-Up and Periodic Evaluation of Beta-Cell Function. Cureus. 2024;16(3):e55771. Published 2024 Mar 8. doi:10.7759/cureus.55771

Sustained metabolic control in latent autoimmune diabetes in adults (LADA) with semaglutide therapy in a patient with multiple autoimmune comorbidities: a case report
Design	Case report
Case presentation	A 55-year-old woman with newly diagnosed type 2 diabetes, class II obesity, and a sedentary lifestyle was initially treated with metformin 1000 mg orally twice daily. Given her history of vitiligo, celiac disease, autoimmune thyroiditis, and arthritis, further testing showed positive GAD antibodies, negative IA2 antibodies, and preserved C-peptide, leading to a diagnosis of Latent Autoimmune Diabetes in Adults (LADA). Semaglutide was initiated at 0.25 mg/week and titrated to 1 mg/week, with metformin discontinued. One year later, worsening thyroid function requiring levothyroxine led to a diagnosis of type 3 autoimmune polyglandular syndrome. In 2023, due to a shortage of injectable semaglutide, she switched to oral semaglutide 7 mg daily and then 14 mg daily for approximately 9 months. Over 5 years of follow-up, she maintained good metabolic control on semaglutide without requiring insulin.
Study Author Conclusions	This case demonstrated that early identification of LADA with preserved β-cell function could be potentially treated with semaglutide as first-line therapy, to obtain good glycemic control, body weight loss, and to preserve β-cell function.

Table 3 References:
[6] D'Andrea S, Berardicurti A, Di Stasi V, et al. Sustained metabolic control in latent autoimmune diabetes in adults (LADA) with semaglutide therapy in a patient with multiple autoimmune comorbidities: a case report and literature review. Acta Diabetol. Published online July 13, 2026. doi:10.1007/s00592-026-02739-9


Design	Case series
Case #1	A 20-year-old woman with obesity and a 9-month history of impaired fasting glucose presented with symptomatic hyperglycemia and was subsequently diagnosed with Latent Autoimmune Diabetes in Adults (LADA) based on high-titer ZnT8, GAD, and IA-2 antibodies and preserved fasting C-peptide of 0.53 nmol/L. Given her partially preserved beta-cell function and need for weight and metabolic control, oral semaglutide 3 mg/day was added to metformin 1000 mg/day and basal insulin (as insulin degludec 8 units daily), then titrated to 14 mg/day while basal insulin was adjusted according to fasting glucose. Metformin was discontinued after 1 month, and an attempt to discontinue basal insulin at 6 months was unsuccessful due to the patient's concern about rising glucose levels. After 1 year, she maintained optimal glycemic control with a glycated hemoglobin (HbA1c) of 5.8% on semaglutide 14 mg/day and low-dose basal insulin without bolus insulin. She also experienced substantial weight loss, with body mass index (BMI) decreasing from 31.8 to 24.9 kg/m² and transitioning from class I obesity to normal weight.
Case #2	A 13-year-old girl with no relevant medical or family history presented with asymptomatic hyperglycemia and was diagnosed with LADA based on high-titer ZnT8, GAD, and IA-2 antibodies, positive anti-TPO antibodies, and detectable fasting C-peptide of 0.33 nmol/L. She was initially treated with multiple daily insulin injections. At 21 months, she had suboptimal glycemic control but persistent beta-cell function and evidence of slow beta-cell decline. Given her desire to discontinue mealtime insulin, prandial insulin was replaced with oral semaglutide 3 mg/day, while daily basal insulin was switched to weekly insulin icodec to improve adherence. Semaglutide was not further titrated because of her low BMI, and basal insulin was adjusted based on fasting glucose. After 15 months of follow-up, she maintained optimal glycemic control with semaglutide and weekly insulin icodec, requiring only occasional low-dose prandial insulin with carbohydrate-rich meals. Her fasting C-peptide also increased modestly from 0.33 nmol/L at diagnosis to 0.48 nmol/L after 36 months.
Study Author Conclusions	Consistent with the current literature, add-on therapy with GLP-1RAs seems to be highly effective in autoimmune diabetes, especially when beta-cell function is still detectable, without substantial safety concerns. Moreover, glucagon-like peptide-1 receptor agonists (GLP-1RAs) may improve metabolic syndrome features and promote weight loss in overweight/obese patients with type I diabetes.

Table 4 References:
[7] Lunati ME, Galesi G, Bernasconi D, Tinari C, Fiorina P. Case Report: Latent autoimmune diabetes in two young female patients successfully treated with oral semaglutide and basal insulin. Front Endocrinol (Lausanne). 2026;17:1833794. Published 2026 Jun 30. doi:10.3389/fendo.2026.1833794