MON-562 - Dual Incretin Therapy as A Metabolic Optimization Strategy in Type 1 Diabetes with Obesity and MASLD: A Case Study .

Objective
To evaluate the metabolic, glycemic, and hepatic effects of adjunctive dual GIP/GLP-1 receptor agonist therapy in an individual with long-standing type 1 diabetes mellitus (T1DM) complicated by obesity and metabolic dysfunction–associated steatotic liver disease (MASLD).
Methods
This case report describes a 45-year-old male with T1DM diagnosed in 2007, obesity, and MASLD, first evaluated at our clinic in July 2024. Baseline assessment included body weight, body composition, continuous glucose monitoring metrics, insulin requirements, and hepatic steatosis assessment using FibroScan®. Adjunctive tirzepatide therapy was initiated at 2.5 mg weekly and titrated to 7.5 mg weekly in combination with an individualized dietary plan and structured lifestyle modification program, with ongoing insulin dose adjustments. Patients were followed longitudinally for 9 months, with repeated metabolic, glycemic, and hepatic assessments.

Results
During follow-up, body weight decreased by 23 kg, attributable entirely to fat mass reduction, with preservation of lean body mass and a mean reduction in visceral fat area of 134 cm². Glycemic control improved substantially, with Time-in-Range increasing from 23% to 77% and basal insulin requirements decreasing by 64% (from 44 to 16 U/day). Follow-up FibroScan®️ demonstrated complete regression of hepatic steatosis from S2 to S0, with a corresponding CAP score reduction from 326 to 198 dB/m. Tirzepatide was well tolerated without hypoglycemia or significant gastrointestinal adverse events.

Conclusion

Adjunctive dual incretin therapy combined with dietary and lifestyle intervention may represent an effective metabolic optimization strategy in selected individuals with T1DM complicated by obesity and MASLD. This case supports further investigation of GIP/GLP-1 receptor agonists as adjunctive therapy in insulin-resistant T1DM populations.

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