TOPLINE:

Among adults with type 1 diabetes (T1D), the initiation of GLP-1-based therapy was associated with a lower risk for all-cause death, several cardiovascular outcomes, all-cause hospitalisations, and hypoglycaemia, without a higher risk for diabetic ketoacidosis.

METHODOLOGY:

• Researchers in Greece conducted a retrospective cohort study utilising real-world data from a global health research network to evaluate the association between GLP-1-based therapy and cardiovascular and renal outcomes in adults with T1D.
• A total of 4088 patients receiving GLP-1-based therapies (median age, 43 years; 34.3% men) were propensity score matched with an equal number of patients not receiving the treatment.
• Evaluated drugs included both GLP-1 receptor agonists and dual glucose-dependent insulinotropic polypeptide/GLP-1 receptor agonists (including liraglutide, dulaglutide, lixisenatide, albiglutide, exenatide, semaglutide, and tirzepatide).
• Outcomes were all-cause death; myocardial infarction (MI); cerebral infarction; adapted major adverse cardiovascular events (MACEs; a composite of heart failure [HF], MI, stroke, cardiac arrest, and coronary revascularisation); chronic kidney disease; HF; and all-cause hospitalisations.
• Safety outcomes included hypoglycaemia and diabetic ketoacidosis. Outcomes were assessed beginning 6 months after therapy initiation.

TAKEAWAY:

• Compared with no GLP-1-based therapy, GLP-1-based therapy was linked to a 33% lower risk for all-cause death (P = .038), a 39% lower risk for adapted MACEs (P = .025), and a 62% lower risk for HF (P = .001).
• GLP-1-based therapy was also associated with a 30% lower risk for all-cause hospitalisation (P = .025); no significant differences were observed for MI, ischaemic stroke, and chronic kidney disease.
• The risk for hypoglycaemia was lower with GLP-1-based therapy (hazard ratio, 0.72; P = .021); however, the risk for diabetic ketoacidosis did not differ significantly between the two groups. Fewer than 10 pancreatitis events (0.2%) occurred in each group.

IN PRACTICE:

"Overall, the absence of an adverse hypoglycemia signal along with the neutral effect on DKA [diabetic ketoacidosis] incidence supports the feasibility and safety of GLP-1- based adjunct treatment in real-world practice," the authors wrote. "These observational findings support the potential role and reassuring safety profile of GLP-1-based therapies in T1D and underscore the need for prospective randomised trials to confirm cardiorenal benefits," they added.

SOURCE:

This study was led by Anastasios Tentolouris, Laiko General Hospital, National and Kapodistrian University of Athens, and Charalampos Filippatos, Alexandra General Hospital, National and Kapodistrian University of Athens, both in Athens, Greece. It was published online on May 06, 2026, in Diabetes, Obesity and Metabolism.

LIMITATIONS:

Longitudinal follow-up data for certain key cardiometabolic measures were not available after baseline. The database did not capture details on treatment adherence, total time on therapy, or switching to other treatments. The duration of diabetes could not be included while matching the cohorts.

DISCLOSURES:

No funding source was reported for the study. Some authors disclosed receiving honoraria for advisory boards and lectures, research support to their institution, or travel grants from several pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.