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GLP-1 Receptor Agonist Therapy and Cardiorenal Outcomes in Type 1 Diabetes: A Propensity-Matched Real-World Analysis

Anastasios Tentolouris1, Charalampos Filippatos2, Nikolaos-Iason Tepetes2

  • 1First Department of Propaedeutic Internal Medicine and Diabetes Center, School of Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece.

Diabetes, Obesity & Metabolism
|May 6, 2026
PubMed
Abstract

Insights

Glucagon-like peptide-1 (GLP-1) based therapies in type 1 diabetes (T1D) are linked to reduced risks of mortality, heart failure, and hospitalizations. This real-world study found no increased risk of diabetic ketoacidosis (DKA) and lower hypoglycemia rates.

Area of Science:

  • Endocrinology
  • Cardiology
  • Nephrology

Background:

  • Limited evidence exists on cardiovascular and renal outcomes with GLP-1 based therapies in type 1 diabetes (T1D).
  • Real-world data is crucial for understanding the safety and efficacy of GLP-1 based therapies in T1D management.
  • Assessing risks of diabetic ketoacidosis (DKA) and hypoglycemia is vital for GLP-1 therapy in T1D.

Purpose of the Study:

  • To evaluate the cardiovascular and renal outcomes associated with GLP-1 based therapies in adults with T1D.
  • To assess the safety profile, including risks of DKA and hypoglycemia, of GLP-1 based therapies in T1D.
  • To analyze major clinical outcomes in a large, real-world cohort of T1D patients using GLP-1 based therapies.

Main Methods:

  • Retrospective cohort study utilizing the TriNetX global health research network.
  • Propensity score matching (1:1) to balance baseline characteristics between GLP-1 exposed and unexposed T1D adults.
  • Analysis of outcomes including mortality, myocardial infarction, heart failure (HF), MACE, CKD, hospitalisation, hypoglycemia, and DKA.

Main Results:

  • GLP-1 therapy was associated with significantly lower risks of all-cause mortality (HR 0.67), HF (HR 0.38), adapted-MACE (HR 0.61), and hospitalisation (HR 0.70).
  • No significant differences were found for myocardial infarction, ischemic stroke, or chronic kidney disease (CKD).
  • GLP-1 therapy showed a lower risk of hypoglycemia (HR 0.72) without an increased incidence of DKA or pancreatitis.

Conclusions:

  • In adults with T1D, GLP-1 based therapy is associated with reduced risks of mortality, HF, MACE, and hospitalisation.
  • The study indicates a lower risk of hypoglycemia and no increased risk of DKA with GLP-1 therapy in T1D.
  • Further randomized controlled trials are recommended to validate these real-world findings.
Keywords:
GLP‐1 receptor agonistscardiovascular outcomesheart failurehospitalisationkidney outcomesmortalitypropensity score matchingtirzepatidetype 1 diabetes

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