GLP-1-Based Therapies in Type 1 Diabetes: Emerging Evidence on Cardiovascular, Renal, and Safety Outcomes

Individuals living with type 1 diabetes (T1D) are at increased risk for cardiovascular (CV) and renal complications, yet therapeutic strategies specifically targeting cardiorenal risk reduction in this population remain limited. The role of glucagon-like peptide-1 (GLP-1)-based therapies in T1D remains unclear.

We conducted a review of published studies examining the CV, clinical, and renal effects of GLP-1-based therapies in people with T1D, while also evaluating safety outcomes and future research priorities.

Three observational real-world studies evaluating GLP-1-based therapies in adults with T1D were identified. Overall, these studies demonstrated clinically meaningful reductions in all-cause mortality, hospitalisation, heart failure, and composite CV outcomes. Renal benefits were also observed, including lower risks of early estimated glomerular filtration rate decline and end-stage kidney disease. Importantly, no consistent increase in diabetic ketoacidosis or severe hypoglycemia was identified, supporting a generally reassuring safety profile. These findings challenge the traditional view of GLP-1 receptor agonists as therapies of predominantly glycemic relevance in T1D and support their potential role in cardiorenal risk reduction. Nevertheless, the currently available evidence is entirely observational and warrants confirmation through prospective randomised studies specifically designed for T1D populations.

Current real-world evidence suggests that GLP-1-based therapies in T1D may provide clinically meaningful CV and renal benefits with a reassuring safety profile; however, adequately powered randomised trials are needed to confirm these findings.