Consensus Report Issues Practical Guidelines for Safe Adjunctive GLP-1 and GLP-1/GIP RA Use in Type 1 Diabetes

Incretin-based therapies, including glucagon-like peptide-1 (GLP-1) receptor agonists (RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) RAs, have revolutionized Type 2 Diabetes (T2D) and obesity management. These agents offer pleiotropic benefits like weight loss, improved glucose regulation, and reduced cardiovascular/renal risk markers. However, despite their potential, they lack regulatory approval for Type 1 Diabetes (T1D) due to limited, inconsistent, and small-scale randomized controlled trials. This gap leaves clinicians and patients without formal guidance for off-label use, increasing potential safety risks such as hypoglycemia and hyperglycemia-related ketosis when used alongside insulin.

An expert panel convened to develop a consensus report and practical guidelines for the safe, adjunctive use of GLP-1 and dual GLP-1/GIP RAs in people with Type 1 Diabetes (T1D). The panel reviewed existing, albeit limited, randomized controlled trials (RCTs) and real-world data concerning the glycemic impacts and safety profiles of these agents in T1D. The objective was to provide structured recommendations for healthcare professionals, addressing the current lack of regulatory approval for this indication and the associated challenges in patient education and optimized diabetes management, particularly regarding necessary insulin dose adjustments.

The consensus report highlights that while GLP-1 and GLP-1/GIP RAs are not yet approved for T1D, their off-label use is occurring, necessitating clear guidance. Key findings emphasize the importance of patient education regarding potential safety risks, primarily hypoglycemia and hyperglycemia-related ketosis, when these agents are initiated. The report underscores the need for careful insulin dose adjustments, as these therapies can significantly impact glucose metabolism.

The guidelines stress that without regulatory approval for the T1D indication, access to crucial education on safe GLP-1 and GLP-1/GIP RA therapy, including expected insulin dose changes, is limited, precluding optimal support from diabetes healthcare professionals. The report acknowledges that larger RCTs are ongoing or planned to further investigate the efficacy and safety of GLP-1 and GLP-1/GIP RA agents as adjunct therapy in T1D participants. It also notes that these drugs are already accessible for T1D patients based on their approval for overweight and obesity, making these guidelines immediately relevant for current clinical practice.