{
  "label": "POST-REGISTRATION ROBUSTNESS (D24) — never replaces a registered verdict",
  "deviation": "D24, item 9 (Saudi E3-i use-context recode; sensitivity analysis)",
  "status": "MODEL-CODED SENSITIVITY. Coded by a Claude model (Anthropic), the same model family as the study coordinator, the first E3-i coder and the blind second coder. It is not human coding and not independent validation.",
  "codedAt": "2026-10-11",
  "population": "Every sampled E3-i naming coded as a type 1 diabetes use (indication-stated, indication-absent or indication-wrong) in docs/evidence/computed/easd-2026-saudi-final-coding.json: 95 namings in 76 answers (before-v4 56, after 39). Namings coded not-a-t1d-use or not-the-agent, and unsampled namings, are outside this file.",
  "procedure": "For each naming, the frozen coded span was located in the frozen pull (sha256 de98a604…) and read with the paragraph that contains it and the heading or paragraph before it; where the span began in a heading, the following paragraph was read. The registered E3-i code was visible to the coder (this is a recode of context, not of status). One context code per (answer sha256, agent).",
  "rules": [
    "R1 glycaemic: the answer presents the type 1 use as an adjunct or add-on to insulin, or states a glucose-related purpose or outcome for it (glycaemic control, blood sugar, HbA1c, time in range, insulin-dose or insulin-requirement reduction). A use described only as an 'adjunct' or 'add-on' in type 1 counts as insulin-adjunct use. Weight named alongside a glucose purpose does not change the code; it sets weightAlsoStated.",
    "R2 weight-management: the type 1 use is presented for obesity, overweight or weight loss in a person with type 1, and no glucose-related purpose and no adjunct-to-insulin framing is stated.",
    "R3 unspecified: neither R1 nor R2 — the molecule is named for type 1 without a stated purpose (product lists, 'may be prescribed off-label', 'specialist uses in selected circumstances', 'potential benefits in type 1 management'), or only for cardiovascular or kidney outcomes, or for unnamed comorbidities.",
    "R4 precedence: R1 is tested first, then R2, then R3. Context is read from the coded span and its paragraph only; status language (approved, off-label) never decides the context.",
    "R5 flags, for re-cutting: weightAlsoStated = weight loss or weight management is named as a purpose or outcome of the same use; populationOverweightOrObese = the use or the cited study is described in people with type 1 and overweight or obesity.",
    "R6 spans: the frozen coded span, with links and URLs replaced by '[link removed]' so no cited site is named in this file."
  ],
  "codes": {
    "0243ce7b3b6849d605e5a890f378762bf202ae7caabb5bf704fdbb88b03a7a91": [
      {
        "agent": "tirzepatide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "HbA1c targets reached (figures from type 2 data) in a type 1 answer.",
        "span": "Local evidence shows oral semaglutide trimming HbA1c by 3.1% at 6 months and tirzepatide enabling 64.1% of patients to reach targets within 40 weeks . ## Cost Considerations Advanced insulins lik"
      }
    ],
    "033ecd3b44811da1403aaa317924801f64a7c50b17a097d82b866e92a5bfe089": [
      {
        "agent": "semaglutide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Used in type 1 as add-on therapy (insulin-adjunct use).",
        "span": "- Among GLP-1 receptor agonists used in Saudi Arabia for type 1 diabetes, semaglutide was the most used (63.9%) followed by liraglutide (34.0%). However, GLP-1 agonists are primarily"
      }
    ],
    "0b39d897e07ccc57de7c718f05d335cea4860786a891ff527ff397ace6050ac5": [
      {
        "agent": "tirzepatide",
        "window": "after",
        "registeredCode": "indication-stated",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Side effects if prescribed for type 1 off-label; no purpose of the type 1 use.",
        "span": "[Gemini answer text withheld]",
        "spanSha256": "c64fd1136eea3b325abcfc399b2b76137bad58241106e2c82efaaf00db395653"
      }
    ],
    "0db69a02420bc237e1c1f1f3798572d09416f48dbe71bada95c2d4f753512a28": [
      {
        "agent": "tirzepatide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Limited specialist uses in selected circumstances; no purpose of the type 1 use.",
        "span": "These may have limited specialist uses in selected circumstances, but they cannot replace insulin; stopping insulin can rapidly cause diabetic ketoacidosis. Although metformin i"
      }
    ],
    "167473e14a27237e8a1dec1c7b4972fbb1eb0084b2d2491055033db48de5776a": [
      {
        "agent": "tirzepatide",
        "window": "after",
        "registeredCode": "indication-stated",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Off-label prescribing for selected adults; no purpose of the type 1 use.",
        "span": "Some may occasionally be prescribed off-label for selected adults, but only under an endocrinologist’s supervision. - **Premixed insulin** is usu"
      }
    ],
    "176915f5a837f8acf0c7481b5ce88ed968ed51655a3970830a78502ccab074a2": [
      {
        "agent": "semaglutide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Added to insulin in type 1; HbA1c, body weight and insulin requirements stated.",
        "span": "P-1 receptor agonists, such as semaglutide and liraglutide, have been investigated for their role in T1D management. A study in Saudi Arabia reported that adding GLP-1 receptor agonists to insuli"
      }
    ],
    "1f70ff6ff8645bb9fcc1cf592d55bf6b936ccdfb74d740229b28b550de5edcf6": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-stated",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Explored for type 1 management; no glycaemic or weight purpose is stated.",
        "span": "[link removed] **GLP-1 Agonists** While primarily approved for type 2 diabetes, GLP-1 agonists like semaglutide are being explored for T1D management. Clinical trials a"
      }
    ],
    "23c321e8c8959f96976f73592302dd657c33ce37319610ae937e342c8de5a8dd": [
      {
        "agent": "sotagliflozin",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Added to insulin in type 1; HbA1c and insulin dose reduction stated, weight loss also.",
        "span": "nied by weight loss and reduction of daily insulin doses with SGLT2 inhibitors (dapagliflozin and sotagliflozin) in combination with insulin."
      }
    ],
    "289a7e210ac9b03c05417b5ec16413f2603367803707f977597f791343015d87": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-stated",
        "context": "glycaemic",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Safety of adjunct use in type 1 (insulin-adjunct); no other purpose stated.",
        "span": "cts and very few serious events reported in the Saudi cohort; however, they are still off-label adjuncts for T1D in many settings.[7][8] | **Popular in Saudi market**: a Saudi T1D cohort used mostly **s"
      }
    ],
    "2ddf72fe446c9e86403249f3e08c9564d5a8604d065b29221dc4733e4224349f": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Emerging adjunct in type 1 to manage blood sugar; weight loss also named.",
        "span": ") **GLP-1 Receptor Agonists** GLP-1 receptor agonists, such as semaglutide, are emerging adjunctive treatments for T1D. They help manage blood sugar levels and may support weight loss. Clinical studies in Sau"
      }
    ],
    "30175e527a58f7efeab4356f58e134f04d4694d528e28ea00b3d60f2ee918fee": [
      {
        "agent": "semaglutide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": true,
        "note": "Added to insulin in type 1 with overweight or obesity; glycaemic control and insulin requirements stated, weight also.",
        "span": "Glucagon-Like Peptide-1 (GLP-1) Agonists:** Recent studies in Saudi Arabia have explored the use of GLP-1 agonists, such as semaglutide, as adjunctive treatments for adults with Type 1 diabetes who are overweight or obese. A retrospective c"
      }
    ],
    "314d3fc5eec3dd1065d8617ce1be2ab8b34c9b75f7d768ddc9be409fdddcf54d": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Adjunct in type 1 that may improve glucose-related measures.",
        "span": "consumer-level caution: - Some newer **adjunct drugs** studied in Saudi Arabia, such as **empagliflozin** or **semaglutide**, may improve glucose-related measures, but they are **not standard core treatment for T1D"
      }
    ],
    "3b4b552484da1b6cbe63cc0e4b6611959a1fb5b520be78eeabefdbfb659381b5": [
      {
        "agent": "semaglutide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Specialist uses in selected circumstances; no purpose of the type 1 use.",
        "span": "Ozempic, Mounjaro, Rybelsus, metformin, or sulfonylureas:** These may have specialist uses in selected circumstances, but they do not replace insulin for type 1 diabetes. Saudi market reports mainly describe these products in the"
      },
      {
        "agent": "tirzepatide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Specialist uses in selected circumstances; no purpose of the type 1 use.",
        "span": "Ozempic, Mounjaro, Rybelsus, metformin, or sulfonylureas:** These may have specialist uses in selected circumstances, but they do not replace insulin for type 1 diabetes. Saudi market reports mainly describe these products in the"
      }
    ],
    "41a7edeeae6be26ae6e5e181a487c29cd60c9be9f6157bacff7d7482eadf9439": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": true,
        "note": "Adjunct in type 1 with overweight or obesity; glycaemic control and insulin requirements stated, weight also.",
        "span": "ective cohort study involving adults with T1D and overweight/obesity found that GLP-1 agonists, such as semaglutide and liraglutide, significantly improved glycemic control, reduced insulin requirements, and led to weight loss without incre"
      }
    ],
    "42c17b6b7672aa0775a993cb4d6e86b45c441a2ed73db02865129b7671d9779c": [
      {
        "agent": "semaglutide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Typically used as adjuncts in type 1 (insulin-adjunct use).",
        "span": "with prescriptions growing 45% annually , though these are typically used as adjuncts in type 1 diabetes rather than primary treatments. ## **Key Takeaway for Saudi Consumers** For type 1 diabetes in KSA, focus on *"
      }
    ],
    "46471bdddee5d631f783b2728f993bb0a425ca526795895649ff18d5ad1954f2": [
      {
        "agent": "tirzepatide",
        "window": "after",
        "registeredCode": "indication-stated",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Off-label in type 1[Gemini answer text withheld]complication risk, used adjunctively with insulin (insulin-adjunct); weight is named first.",
        "span": "[Gemini answer text withheld]",
        "spanSha256": "16ad92e319d3aed3b6791e00b0aa6a585dbb785b233bfae8950104e9b12c931f"
      }
    ],
    "4804367774867b3939fd86f526a873990a8fdb173ee5827edd110def5daa31eb": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-stated",
        "context": "glycaemic",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Trials of efficacy alongside insulin therapy in type 1 (insulin-adjunct use).",
        "span": "Clinical trials are ongoing in Saudi Arabia to assess its efficacy alongside insulin therapy. [link removed]"
      }
    ],
    "4941e0d2983891a667ac23936a57763278752626fca168a68f6b014523b1b6f9": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-stated",
        "context": "glycaemic",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Explored as an adjunct to insulin therapy in type 1.",
        "span": "Clinical trials are ongoing in Saudi Arabia to assess their efficacy and safety. [link removed]"
      }
    ],
    "4a643c569fb8cfed1099677ed1e595b17f863383477f27d685fb9b08038492e2": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-stated",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": true,
        "note": "Off-label in type 1 with obesity or insulin resistance; blood glucose benefit stated, weight also.",
        "span": "[Gemini answer text withheld]",
        "spanSha256": "2c581c655c3b034688b567131fe0d1e6701ae27a09b3d767f5c231ee2d17f49e"
      },
      {
        "agent": "tirzepatide",
        "window": "before-v4",
        "registeredCode": "indication-stated",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": true,
        "note": "Off-label in type 1 with obesity or insulin resistance; blood glucose benefit stated, weight also.",
        "span": "[Gemini answer text withheld]",
        "spanSha256": "2c581c655c3b034688b567131fe0d1e6701ae27a09b3d767f5c231ee2d17f49e"
      }
    ],
    "4e9196511c875c4557fad3aa547804291f206037bfac727693fe0642533f01b1": [
      {
        "agent": "semaglutide",
        "window": "after",
        "registeredCode": "indication-stated",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Generic product offered as an affordable entry point, type 2 indication stated; no purpose of the type 1 use.",
        "span": "The generic semaglutide option (Glucentra®) offers a more affordable entry point to newer therapies, though it's primarily indicated for type 2 diabetes. Availability through hospital pharmacies (56.12% of distribution) is more reli"
      }
    ],
    "51283fc6e3091f2648c2ae43a3c3ae1efd6270f68e780f3389e64db4da1123b6": [
      {
        "agent": "semaglutide",
        "window": "after",
        "registeredCode": "indication-stated",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "May be considered in specialised circumstances; no purpose of the type 1 use.",
        "span": "t replace insulin.** - GLP-1 medicines and SGLT2 inhibitors may be considered only in specialised circumstances and under an endocrinologist; they are primarily type 2 diabetes or obesity tre"
      },
      {
        "agent": "tirzepatide",
        "window": "after",
        "registeredCode": "indication-stated",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "May be considered in specialised circumstances; no purpose of the type 1 use.",
        "span": "t replace insulin.** - GLP-1 medicines and SGLT2 inhibitors may be considered only in specialised circumstances and under an endocrinologist; they are primarily type 2 diabetes or obesity tre"
      }
    ],
    "526566bac0f2be61564ab7faac5ec0360ed2d605ffbed027b02ee6352e492592": [
      {
        "agent": "semaglutide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Cardiovascular and kidney outcome figures in a type 1 answer; no glycaemic or weight purpose.",
        "span": "e kidney disease were reduced by 15% and 19%, respectively, for patients taking GLP-1-RA drugs such as semaglutide (Ozempic) and tirzepatide (Mounjaro) . - **Better glucose monitoring outcomes**: CGM use"
      },
      {
        "agent": "tirzepatide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "HbA1c goals reached (figures from type 2 data) in a type 1 answer.",
        "span": "Tirzepatide hits HbA1c goals for nearly two-thirds of local users, yet the out-of-pocket burden still deters uptake . **Technology Adoption**: Pa"
      }
    ],
    "57529322106a5b02af211588a590385bedc2a319f9171900cc8b874653da0c9d": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "HbA1c reduction attached (figures from type 2 data) in a type 1 answer.",
        "span": "For patients with access and resources, oral semaglutide trimmed HbA1c by 3.1% at 6 months and tirzepatide enabled 64.1% of patients to reach targets within 40 weeks ,"
      },
      {
        "agent": "tirzepatide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "HbA1c targets reached (figures from type 2 data) in a type 1 answer.",
        "span": "th access and resources, oral semaglutide trimmed HbA1c by 3.1% at 6 months and tirzepatide enabled 64.1% of patients to reach targets within 40 weeks , though premium pricing limits access even though GLP-1"
      }
    ],
    "5e1c5b781ab4a52c62255d5bbaa0bf78204510b7a113268f3330fff89f327244": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "HbA1c reduction attached (figures from type 2 data) in a type 1 answer; weight reductions also named.",
        "span": "For newer treatments available in Saudi Arabia, oral semaglutide trims HbA1c by 3.1% at 6 months and tirzepatide enables 64.1% of patients to reach targets within 40 weeks, w"
      },
      {
        "agent": "tirzepatide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "HbA1c targets reached (figures from type 2 data) in a type 1 answer; weight reductions also named.",
        "span": "available in Saudi Arabia, oral semaglutide trims HbA1c by 3.1% at 6 months and tirzepatide enables 64.1% of patients to reach targets within 40 weeks, with notable weight reductions ."
      }
    ],
    "665d17915d6686715aa0f2fd9870a48d52cdf1a31281b6ac07235dcba4b072cb": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": true,
        "note": "Adjunct in type 1 with obesity; glycaemic control and insulin requirements stated, weight also.",
        "span": "A 2023 study in Saudi Arabia evaluated the use of GLP-1 agonists, such as semaglutide and liraglutide, as adjunctive treatments in adults with T1D and obesity. The findings indicated significant improvements in glycem"
      }
    ],
    "66751f3af3e9ee98afc68833bb7918cd0d99ed21795b70d07f8a346e80562c10": [
      {
        "agent": "tirzepatide",
        "window": "before-v4",
        "registeredCode": "indication-stated",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Product listing says it may be prescribed off-label for type 1; no purpose of the type 1 use is stated.",
        "span": "While primarily for type 2 diabetes, it may be prescribed off-label for type 1 diabetes under specific medical guidance. [link removed]"
      }
    ],
    "6d039c4c86282115629b4a96f6bb38f0f1b2aff16822e699a5207fab8cc6e300": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Listed in a table of products relevant to type 1 diabetes; no purpose stated.",
        "span": "diabetes | Why they matter for a KSA buyer | |---|---|---| | **Novo Nordisk** | NovoRapid, Levemir, Tresiba, Ozempic, Victoza, Xultophy | Widely cited as a KSA leader; strong insulin portfolio and Saudi-spe"
      },
      {
        "agent": "tirzepatide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Listed in a table of products relevant to type 1 diabetes; no purpose stated.",
        "span": "orted local manufacturing/supply activity in KSA.[4][6][11] | | **Eli Lilly** | Humalog, Trulicity, Mounjaro | Major insulin player with strong global diabetes reputation and KSA market presence.[1]"
      }
    ],
    "6d37e9ef7196d4a8181a696e18daac98a5eae0c30c84f1160d98252083170e5c": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": true,
        "note": "Added to insulin in type 1 with overweight or obesity; HbA1c and time in range stated, weight also.",
        "span": "Recent studies in Saudi Arabia have explored the use of GLP-1 agonists, such as semaglutide, as adjunctive therapy in adults with T1D who are overweight or obese. A retrospective cohort study conducted be"
      }
    ],
    "6d57b6d260f683241a2824519e0ef2cbe69ea6e4a9790f12cc56523c6d0f6495": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Used to manage blood sugar levels in type 1; appetite and weight also named.",
        "span": "or Agonists (e.g., Semaglutide)** GLP-1 receptor agonists, such as semaglutide, are used to manage blood sugar levels in T1D patients. They can help reduce appetite and support weight loss, which is beneficial for overall h"
      }
    ],
    "6dc2cd249fd08edcb588d513d2c1da49cf64a85d48b302208a5a359bf374755d": [
      {
        "agent": "semaglutide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Adjunctive therapy in type 1; HbA1c reduction stated, body weight also.",
        "span": "Agonists:** A retrospective cohort study from Saudi Arabia compared GLP-1 receptor agonists (e.g., semaglutide) with SGLT2 inhibitors in T1D patients over 12 months. The study found that GLP-1 receptor agonists led to significant"
      }
    ],
    "723868b16c0d266920543b5588c7bb7c7aba6e93b1f03566dc52f89ccd1118a4": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-stated",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Listed as a type 1 option whose stated benefit is improved glycaemic control, with weight loss also named.",
        "span": "- *Cons:* Not yet approved for T1D; potential for increased hypoglycemia risk."
      }
    ],
    "736af9790510bb69d8d1667b9c004b01e22274185d15dc5b8e20446fd56a13fc": [
      {
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        "populationOverweightOrObese": false,
        "note": "Investigated in type 1 trials and not for use in type 1; no purpose stated.",
        "span": "[Gemini answer text withheld]",
        "spanSha256": "a9a95c89d5753f6c227a6a6d30441e6f4ae829a3ba099e7701469825fed03755"
      }
    ],
    "7b1bbe963054743d1fa36d0d0abbddf21146987030646f86c3dd4b5b4af23580": [
      {
        "agent": "semaglutide",
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        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "HbA1c reductions in a type 1 answer; weight loss also named.",
        "span": "Once-weekly insulin icodec promises higher adherence, and local evidence shows oral semaglutide and tirzepatide are delivering significant HbA1c reductions and weight loss benefits."
      },
      {
        "agent": "tirzepatide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "HbA1c reductions in a type 1 answer; weight loss also named.",
        "span": "Once-weekly insulin icodec promises higher adherence, and local evidence shows oral semaglutide and tirzepatide are delivering significant HbA1c reductions and weight loss benefits."
      }
    ],
    "7bae4008c83d1c4c93e66276edf3ef41365fc22e46e64775414d51facee156ee": [
      {
        "agent": "tirzepatide",
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        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Use as an adjunct in type 1 under an endocrinologist (insulin-adjunct use).",
        "span": "t they are not replacements for insulin in type 1 diabetes; use as an adjunct would require an endocrinologist and is not appropriate for every patient.[2][6] ## Best-value expectations For many Saudi patients, a **basal–bolus regi"
      }
    ],
    "7e26d71e9beac4ee8072fecd1f788eb325afe4b8bcc46197da7845c2cad48716": [
      {
        "agent": "semaglutide",
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        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Added to insulin in type 1; HbA1c and insulin requirements stated, body weight also.",
        "span": "**Additional Considerations:** In Saudi Arabia, adjunctive therapies such as GLP-1 receptor agonists (e.g., semaglutide) are being explored for their potential benefits in T1D management. A study conducted in Riyadh found that adding semagl"
      }
    ],
    "82772f1aa4ba46fc5d6c581ce370a563c188f5fcd9adbf1490c5716411bc6723": [
      {
        "agent": "semaglutide",
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        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Added to insulin in type 1; HbA1c reduction stated, body weight also.",
        "span": "- **GLP-1 Receptor Agonists:** Medications like semaglutide and liraglutide have been evaluated for their efficacy in T1D management. A multicenter study in Riyadh found that adding GLP-1 receptor agonists to insulin thera"
      }
    ],
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        "populationOverweightOrObese": false,
        "note": "HbA1c reduction attached (figures from type 2 data) in a type 1 answer; weight reductions also named.",
        "span": "- **GLP-1 Receptor Agonists**: Local evidence shows oral semaglutide trimming HbA1c by 3.1% at 6 months and tirzepatide enabling 64.1% of patients to reach targets within 40 weeks,"
      },
      {
        "agent": "tirzepatide",
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        "note": "HbA1c targets reached (figures from type 2 data) in a type 1 answer; weight reductions also named.",
        "span": "*: Local evidence shows oral semaglutide trimming HbA1c by 3.1% at 6 months and tirzepatide enabling 64.1% of patients to reach targets within 40 weeks, with combined notable weight reductions driving rapid u"
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    ],
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        "note": "Adjunct use in type 1 (insulin-adjunct); weight loss also named as a reason for popularity.",
        "span": "ta show no significant hypoglycemia or DKA in a small retrospective cohort, but evidence is still off-label and not standard T1D therapy[8][11] | Popular for weight loss and adjunct use, but not fi"
      }
    ],
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        "populationOverweightOrObese": true,
        "note": "Adjunct in type 1 with overweight or obesity; glycaemic control and insulin requirements stated, weight also.",
        "span": "GLP-1 Agonists as Adjunctive Therapy:** Recent studies in Saudi Arabia have explored the use of GLP-1 agonists, such as semaglutide, as adjunctive treatments in adults with T1D and overweight or obesity. Findings indicate that GLP-1 agonist"
      }
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      {
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        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "May be prescribed as adjuncts in selected type 1 cases (insulin-adjunct use).",
        "span": "These medicines may occasionally be prescribed as adjuncts in selected cases, but stopping insulin can cause DKA. Saudi market reports list Ozempic and simi"
      },
      {
        "agent": "tirzepatide",
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        "note": "May be prescribed as adjuncts in selected type 1 cases (insulin-adjunct use).",
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      }
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        "span": "LP-1 Receptor Agonists**: A retrospective cohort study in Saudi Arabia compared GLP-1 receptor agonists (e.g., semaglutide) with SGLT2 inhibitors in T1D patients over 12 months. The study found that GLP-1 receptor agonists led to significan"
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        "span": "lore newer medications, recent research on GLP-1 receptor agonist drugs such as semaglutide (Ozempic) and tirzepatide (Mounjaro) shows the five-year risk of major cardiovascular events and the risk of end-stage kidney"
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      {
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        "note": "Cardiovascular and kidney outcome figures in a type 1 answer; no glycaemic or weight purpose.",
        "span": "lore newer medications, recent research on GLP-1 receptor agonist drugs such as semaglutide (Ozempic) and tirzepatide (Mounjaro) shows the five-year risk of major cardiovascular events and the risk of end-stage kidney"
      }
    ],
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        "note": "Listed among products for type 1 diabetes, then qualified as mainly type 2; no purpose stated.",
        "span": "Xultophy** from Novo Nordisk; **Lantus, Toujeo, and Soliqua** from Sanofi; and **Humalog, Trulicity, and Mounjaro** from Eli Lilly.[7] That said, for **type 1 diabetes**, the core products are the **insulins** rather tha"
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    ],
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        "span": "For patients taking GLP-1-RA drugs like semaglutide and tirzepatide, the five-year risk of major cardiovascular events and end-stage kidney disease were redu"
      }
    ],
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      {
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    ],
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        "note": "Generic product offered as an affordable option in a type 1 answer; no purpose of the type 1 use.",
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    ],
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    ],
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        "note": "Listed in a table of products relevant to type 1 diabetes; no purpose stated.",
        "span": "ablished KSA presence and broad diabetes footprint.[9][2] | | **Eli Lilly** | **Humalog, Trulicity, Mounjaro** | Important in insulin and advanced diabetes therapy; strong tertiary-hospital relevanc"
      }
    ],
    "aaed3d99eb26ab24f89a9d6a84a94821f1d00a6c298d436c8913ef37b352003d": [
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        "populationOverweightOrObese": false,
        "note": "Used to manage blood sugar in type 1; weight loss also named.",
        "span": "A study from Saudi Arabia found that GLP-1 receptor agonists effectively improve glycemic control in T1D patients. [link removed]"
      }
    ],
    "b4c9224002ed6de7822108bf7b8a01d07e29c3325efbd777dd882f300ccaffff": [
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        "agent": "semaglutide",
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        "note": "Off-label use for selected comorbidities; the comorbidity is not named.",
        "span": "They may occasionally be used off-label for selected comorbidities, but evidence and regulatory indications differ. - **“Natural insulin,” herbs,"
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      {
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        "span": "They may occasionally be used off-label for selected comorbidities, but evidence and regulatory indications differ. - **“Natural insulin,” herbs,"
      }
    ],
    "b64378fa12bab92a3e571058be39b459e7f8d7d75ef91498d863924cf4d97b76": [
      {
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        "populationOverweightOrObese": false,
        "note": "Complementary option in type 1 for enhanced glycaemic control and metabolic benefits.",
        "span": "ely available, established clinical experience - **Alternative/Complementary**: GLP-1 therapies like semaglutide (now with generic approval) for enhanced glycemic control and metabolic benefits - **Access**: Utilize public hospita"
      }
    ],
    "bd33a1fc8d91113806f682844bae8f4e2a2bb4ee029f5883e7781aca6bc8846b": [
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        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Side effects of non-insulin add-ons in type 1 (insulin-adjunct use).",
        "span": "eceptor agonists** have mainly **GI side effects** such as nausea and vomiting; Saudi real-world data on semaglutide reported GI problems as the most common adverse effect, and other Saudi studies similarly"
      }
    ],
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      {
        "agent": "semaglutide",
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        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Off-label add-on to insulin in type 1 to improve glycaemic control and reduce weight.",
        "span": "[Gemini answer text withheld]",
        "spanSha256": "8be1d08b91d5e2f12b318136a034f23ef61c852abb10e2ecd5fa1b7cc0213ca2"
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        "note": "Not approved for type 1; off-label use mentioned without a stated purpose.",
        "span": "[Gemini answer text withheld]",
        "spanSha256": "5cfcc0a8dd88682e1106d607ed1b7ea80acd11649e1eb81b77245836b5bd3a0b"
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      {
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        "span": "[Gemini answer text withheld]",
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        "note": "Add-on therapy in type 1 to reduce insulin doses (insulin-adjunct use); weight management is named first.",
        "span": "[Gemini answer text withheld]",
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      {
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        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Investigated in type 1 for improved glycaemic control, with weight reduction also named.",
        "span": "[Gemini answer text withheld]",
        "spanSha256": "f25ad3a85ad822cf2214e2bef8a5c25cc01fcf3b64c5a81b2ab3c0d2662d7e48"
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      {
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        "note": "Trials in type 1 with obesity or overweight; improved blood sugar is a stated outcome, weight loss also.",
        "span": "[Gemini answer text withheld]",
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        "agent": "semaglutide",
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        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Market-share description, stated as not specifically for type 1; no purpose of a type 1 use.",
        "span": "ovy)** - Semaglutide was the largest segment with 73.9% revenue share in 2025 - Semaglutide is the most widely used GLP-1 RA in Saudi Arabia, accounting for over 70% of all public-sector market share - Growing availability but les"
      },
      {
        "agent": "tirzepatide",
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        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Heading in a type 1 options answer with promising glycaemic control; weight loss also named.",
        "span": "### **Tirzepatide (Mounjaro)** - Tirzepatide is expected to become increasingly available in Saudi Arabia and has shown promising glycemic control and weight loss - Tirzepatide is"
      }
    ],
    "c5a9dda0d30534cad644a9dca9d3b44dc4b0248a7d9cdf874acd7cd88de82c8d": [
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        "note": "Add-on to insulin in type 1; glycaemic control and insulin requirements stated, body weight also.",
        "span": "[Gemini answer text withheld]",
        "spanSha256": "3048ec3e566d4c586a1336a1b8cb041046d724e3d9f682de23e05183ccb38be3"
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    ],
    "c70872eddc0052a94e6302e2c4b8e77522c408a1497fc30eae392400518d2d1c": [
      {
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        "note": "Adjunctive treatment in type 1 with insulin; glycaemic control stated, body weight also.",
        "span": "[Gemini answer text withheld]",
        "spanSha256": "6466c6e333d6f2d57fbe309cc8a2d884dfc81c2a0d7e8e588ad82fe40b3a2aa9"
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    ],
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      {
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        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Described as an adjunct in type 1 (insulin-adjunct use); no other purpose stated.",
        "span": "nsumer-friendly” upgrade for everyone.[1] - **Semaglutide** and **liraglutide** were the main GLP-1 agonists reported in a Saudi retrospective cohort, but these are *adjuncts* and not standard replacement therapy for type 1 diabetes.[6] -"
      }
    ],
    "cd52719dad6362c51c10a54b8b88ccacf266294af3b7be3171f6e376cf0fea93": [
      {
        "agent": "semaglutide",
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        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Studied for potential benefits in type 1 management; no glycaemic or weight purpose is stated.",
        "span": "Clinical trials are ongoing to assess their efficacy and safety in this context. [link removed]"
      }
    ],
    "d147019defa12c4130427f76f09932d109e9bec4d1309849889c56a0e57690c2": [
      {
        "agent": "semaglutide",
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        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": true,
        "note": "Adjunct in type 1 with overweight or obesity; glycaemic control and insulin requirements stated, weight also.",
        "span": "Recent studies in Saudi Arabia have explored the use of GLP-1 agonists, such as semaglutide and liraglutide, as adjunctive treatments for adults with Type 1 diabetes who are overweight or obese. These medications have shown"
      }
    ],
    "d2e253a7a628ed36f67cae6e8ce3d0a72c933dcddba244d3da21473966546c4e": [
      {
        "agent": "semaglutide",
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        "weightAlsoStated": true,
        "populationOverweightOrObese": true,
        "note": "Adjunct in type 1 with overweight or obesity; glycaemic control and insulin requirements stated, weight also.",
        "span": "The findings indicated significant improvements in glycemic control, weight reduction, and insulin requirements, suggesting a promising role for GLP-1 agonists in T1D management. [link removed]"
      }
    ],
    "d7cc5558514500e86031a499055c6ed200522e0ba2e60b739b25482499a971f8": [
      {
        "agent": "semaglutide",
        "window": "after",
        "registeredCode": "indication-stated",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Prescribed for selected off-label or coexisting conditions; no purpose of the type 1 use.",
        "span": "Some may be prescribed for selected off-label or coexisting conditions, but they do not replace basal insulin in type 1 diabetes. Stopping insulin can"
      },
      {
        "agent": "tirzepatide",
        "window": "after",
        "registeredCode": "indication-stated",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Prescribed for selected off-label or coexisting conditions; no purpose of the type 1 use.",
        "span": "Some may be prescribed for selected off-label or coexisting conditions, but they do not replace basal insulin in type 1 diabetes. Stopping insulin can"
      }
    ],
    "d91124520c8bfcb4654ff29de153f112d6306c4171bdf058602a631489d94264": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-stated",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Studied for potential benefits in type 1 management; no glycaemic or weight purpose is stated.",
        "span": "Clinical trials are ongoing to assess its efficacy and safety in this context. [link removed]"
      }
    ],
    "de000744d285df8b986427c4cd3f8ecdfbeb9c4260e3bf22a967a1d2ef7a93bb": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Adjunct cohort in type 1: HbA1c and time in range improved, weight loss also named.",
        "span": "nfections**.[2] - In a Saudi retrospective cohort of adjunct **GLP-1 agonists**—mostly **semaglutide** and some **liraglutide**—HbA1c improved by **0.84%**, time-in-range improved by **15%**,"
      }
    ],
    "dec2ad988c49fd9a030685fac7eaf162325e639809ae8efbadea55cab5d26da8": [
      {
        "agent": "semaglutide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Evaluated for efficacy in managing type 1; no glycaemic or weight purpose is stated.",
        "span": "[link removed] **GLP-1 Receptor Agonists** GLP-1 agonists, such as semaglutide, have been evaluated for their efficacy in managing T1D. A study from Saudi Arabia compared GLP-1 receptor agonists with SGLT2 inhibito"
      }
    ],
    "dee751c82f5385da218822f1999fbcfb16a459880f49fe281db9bdb4ab2313dd": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": true,
        "note": "Adjunct in type 1 with overweight or obesity; glycaemic control and insulin requirements stated, weight also.",
        "span": "ted in Saudi Arabia between January 2022 and February 2023 evaluated the use of GLP-1 agonists, such as semaglutide and liraglutide, as adjunctive therapy in adults with T1D and overweight/obesity. The study found that GLP-1 agonists signif"
      }
    ],
    "e859e1ecedcaf125d64b27f23402936ecee1acd9908a03a5886c88744d3be600": [
      {
        "agent": "semaglutide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Cardiovascular and kidney outcome figures in a type 1 answer; no glycaemic or weight purpose.",
        "span": "For patients taking GLP-1 receptor agonist drugs such as semaglutide (Ozempic) and tirzepatide (Mounjaro), the five-year risk of major cardiovascular events such as heart attacks and th"
      },
      {
        "agent": "tirzepatide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Cardiovascular and kidney outcome figures in a type 1 answer; no glycaemic or weight purpose.",
        "span": "For patients taking GLP-1 receptor agonist drugs such as semaglutide (Ozempic) and tirzepatide (Mounjaro), the five-year risk of major cardiovascular events such as heart attacks and th"
      }
    ],
    "f29bc85e567b10b137c29f07c6c04e33f9dc5476f715adeee7f99abdb0cba5f3": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": true,
        "note": "Adjunct in type 1 with overweight or obesity; glycaemic control and insulin requirements stated, weight also.",
        "span": "Recent studies in Saudi Arabia have explored the use of GLP-1 agonists, such as semaglutide and liraglutide, as adjunctive treatments in adults with Type 1 diabetes who are overweight or obese. These medications have shown"
      }
    ],
    "f41f944dea1c537f92390354acff1cdad2e2847b4306b02acec186168b9fac5f": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Offered as a medicine add-on to insulin in type 1 (insulin-adjunct use).",
        "span": "If you mean **medicine add-ons to insulin**, the **safest-looking adjunctive option in Saudi data is GLP-1 receptor agonists** (for example, **semaglutide** and **liraglutide**), because Saudi studies reported **no"
      }
    ],
    "f786f03702120d285dc9151e8e56ec0bdee772b6f684d614eff40db40584d19c": [
      {
        "agent": "semaglutide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Prescribed for selected adjunctive circumstances in type 1 (insulin-adjunct use).",
        "span": ", GLP-1 medicines such as semaglutide, and SGLT2 inhibitors may occasionally be studied or prescribed for selected adjunctive circumstances, but they do not replace insulin in T1D. SGLT2 medicines can increase the risk"
      }
    ],
    "f91439aa545316f82ee30827ca66d09af53c5709f8f0dcfeea77902d532bb48b": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": true,
        "note": "Adjunct to insulin in adults with type 1 and overweight or obesity; glycaemic control and insulin requirements are stated outcomes, weight also.",
        "span": "conducted in Saudi Arabia in 2023 evaluated the use of GLP-1 agonists, such as semaglutide and liraglutide, as adjunctive treatments in adults with T1D and overweight/obesity. The study found significant improvements in gl"
      }
    ],
    "f9591795c9b3b7a29fb348b38c33dbcf40b6b5738e271ceed1f6209b5db21692": [
      {
        "agent": "tirzepatide",
        "window": "after",
        "registeredCode": "indication-absent",
        "context": "unspecified",
        "weightAlsoStated": false,
        "populationOverweightOrObese": false,
        "note": "Cardiovascular and kidney outcome figures in a type 1 answer; no glycaemic or weight purpose.",
        "span": "Prevention For patients taking GLP-1 receptor agonist drugs such as semaglutide (Ozempic) and tirzepatide (Mounjaro), the five-year risk of major cardiovascular events is reduced by 15% and the ri"
      }
    ],
    "fca1265a734eea68e976cb758cfdfa5677773c6f97758b22d737ab46e60293f6": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": true,
        "note": "Adjunct in type 1 with overweight or obesity; glycaemic control and insulin requirements stated, weight also.",
        "span": "Recent studies in Saudi Arabia have explored the use of GLP-1 agonists, such as semaglutide, as adjunctive therapy in adults with T1D who are overweight or obese. Findings indicate that GLP-1 agonists can"
      }
    ],
    "fe0b4183a0925f4d8db99ec9ece6d8161c370986e00f69c19ed12ac32e8bf34b": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-absent",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": true,
        "note": "Added to insulin in type 1 with overweight or obesity; HbA1c and time in range stated, weight also.",
        "span": "A retrospective cohort study conducted in Saudi Arabia between January 2022 and February 2023 found that adding semaglutide to insulin therapy resulted in a significant reduction in HbA1c levels, improved time in range (TIR), and weight los"
      }
    ],
    "ff7ed4bc7cc9f56ae9798bc47bd0f180ce9a43ce5cc74923ca6d9a648f66c447": [
      {
        "agent": "semaglutide",
        "window": "before-v4",
        "registeredCode": "indication-stated",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Adjunct in type 1 to[Gemini answer text withheld] weight management also named.",
        "span": "[Gemini answer text withheld]",
        "spanSha256": "389b1ba936f846682416732511933b9dfc20a537c2e9d172ad30b2facead8070"
      },
      {
        "agent": "tirzepatide",
        "window": "before-v4",
        "registeredCode": "indication-stated",
        "context": "glycaemic",
        "weightAlsoStated": true,
        "populationOverweightOrObese": false,
        "note": "Adjunct in type 1 to[Gemini answer text withheld] weight management also named.",
        "span": "[Gemini answer text withheld]",
        "spanSha256": "389b1ba936f846682416732511933b9dfc20a537c2e9d172ad30b2facead8070"
      }
    ]
  }
}