Adjunctive Treatments for Patients with Type 1 Diabetes Using Automated Insulin Delivery Systems. A Narrative Review

Automated Insulin Delivery (AID) systems represent the most effective and safe treatment for the management of type 1 diabetes (T1D). Antidiabetic agents used for the treatment of type 2 diabetes, such as the Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists (RAs), the dual Glucose-dependent Insulinotropic Polypeptide and GLP-1 RA and the Sodium-Glucose co-Transporter 2 inhibitors are associated with clinically significant weight loss and cardioprotective effect. Given the increased prevalence of overweight, obesity, and cardiovascular risk in patients with T1D, the addition of these medications to AID treatment is of considerable clinical interest. In this review limited data from randomized controlled and observational trials show that in overweight and obese patients with T1D treated with AID, the addition of weekly semaglutide, or tirzepatide is associated with significant weight loss, reduction in total daily insulin dose and increase in Time In target Range (TIR) without increased risk for hypoglycemia and Diabetic Ketoacidosis (DKA). Similarly, adjunctive treatment with empagliflozin resulted in increased TIR without increase in hypoglycemia, reduction in insulin requirements, and increase in the mean plasma ketone value, although DKA remained rare. However, studies of longer duration with more participants are required to establish the long-term safety and efficacy of these interventions in patients with T1D treated with AID.