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Glucagon-like peptide-1 receptor agonists for major cardiovascular and kidney outcomes in type 1 diabetes
Key Points
- To evaluate the long-term effects of glucagon-like peptide-1 receptor agonists on cardiovascular and kidney outcomes in type 1 diabetes.
- Analyzed national electronic health record data from 174,678 patients with type 1 diabetes.
- Conducted a sequential target trial emulation from January 2013 to March 2024.
- Applied propensity score weighting to assess the impact of GLP-1RA initiation.
- GLP-1RA initiation resulted in a 0.7% lower risk of major adverse cardiovascular events after 5 years.
- The 5-year risk of end-stage kidney disease was 0.3% lower with GLP-1RA use.
- No increase in hospitalization rates for diabetic ketoacidosis or severe hypoglycemia was observed.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
MHMartin HaluzíkProfessor of Medicine, Head of Diabetes Centre
“Very important data that have been largely missing so far Similar MACE reduction as in T2DM (15 %) and 19 % reduction in end stage kidney disease No increase risk of severe side effects such as ketoacidosis or severe hypoglycemia I believe that the time has come to officially recommend use of GLP-1 RAs in type 1 diabetes patients. It is safe and very likely cardo- and nephroprotective”
SBSanjeev BagaiSenior Consultant Paediatrician and Nephrologist
“GLP-1RA was asso with signifrisks of major adverse CVS events (5-year risk: 4.3% vs 5.0%; risk diff: −0.7%; (HR): 0.85 & ESRD (5-year risk: 1.6% vs 1.9%; risk diff: −0.3%; HR: 0.81.”
“GLP-1RAs may be beneficial against major adverse cardiorenal events in patients with type 1 diabetes, without compromising safety.”
Implication
A sequential target trial finds glucagon-like peptide-1 receptor agonists reduce major cardiovascular and kidney issues in type 1 diabetes, indicating potential benefits.
Abstract
There is substantial interest in the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) in type 1 diabetes, but data on the long-term clinical outcomes are lacking. Using national electronic health record data from 174,678 patients with type 1 diabetes, we conducted a sequential target trial emulation from January 2013 to March 2024. After propensity score weighting, GLP-1RA initiation was associated with significantly lower risks of major adverse cardiovascular events (5-year risk: 4.3% versus 5.0%; risk difference: −0.7% (95% confidence interval (CI): −1.2% to −0.2%); hazard ratio (HR): 0.85 (0.77–0.95)) and end-stage kidney disease (5-year risk: 1.6% versus 1.9%; risk difference: −0.3% (−0.6% to 0%); HR: 0.81 (0.69–0.95)). No increased risks of hospitalization for diabetic ketoacidosis or severe hypoglycemia were observed. These findings suggest that GLP-1RAs may be beneficial against major adverse cardiorenal events in patients with type 1 diabetes, without compromising safety. A trial emulation study using electronic health record data from 174,678 patients with type 1 diabetes revealed that GLP-1RA initiation is associated with reduced risk of major cardiovascular events and end-stage kidney disease.
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Cite This Study
XU et al. (2026) studied this question.