Efficacy and safety of GLP ‐1 receptor agonists and SGLT2 inhibitors as adjuncts to insulin in type 1 diabetes: Systematic review and meta‐analysis
Authors' conclusion
Adjunctive GLP-1RAs and SGLT2is provide modest clinical improvements in adults with type 1 diabetes. These benefits must be balanced against class-specific safety concerns, especially the increased risk of DKA with SGLT2-based therapies. Larger, long-term trials are needed to define their optimal use in routine care.
Study context
- Population
- Patients with T1D on insulin; studies in PubMed, Ovid MEDLINE, Embase, Web of Science, Scopus and Cochrane Library through 26 September 202590 studies
- Comparison
- GLP-1 RA or SGLT2i as adjuncts to insulin in T1D
- Outcome
- Glycaemic control, insulin requirements, weight and BMI
Methodological detailsrandom-effects model, risk of bias analyses
- Random-effects model
- Risk of bias analyses
Pooled result
As reported in the abstract
- GLP-1RAs: HbA1c
- −0.56%
- GLP-1RAs: body weight
- −3.6 kg
- GLP-1RAs: Body mass index (BMI)
- −1.05 kg/m²
- SGLT2is: HbA1c
- −0.38%
- SGLT2is: Time-in-range (TIR)
- +8.6 pp
- SGLT2is: insulin requirements
- −4.7 U/day
- SGLT2is: body weight
- −2.5 kg
- SGLT2is: BMI
- −0.82 kg/m²
Further pooled results
Renal and CV outcomes
- GLP-1RAs: renal and CV outcomes neutral
- SGLT2is: renal parameters stable or improved; CV events infrequent
Mortality and hospitalisations
- Across drug classes, mortality and hospitalisations were rare
Safety
Diabetic ketoacidosis (DKA) risk
- DKA risk was increased, primarily in predictable clinical settings
- RR 2.19 (95% CI 1.16-4.17)
- Increased risk of DKA with SGLT2-based therapies (authors' conclusion)
- Severe hypoglycaemia was uncommon
GLP-1 RA safety
- Severe hypoglycaemia and DKA were rare; GI adverse effects most common; renal and CV outcomes neutral
SGLT2i renal and CV safety
- Renal parameters remained stable or improved; CV events were infrequent
Original publication
Efficacy and safety of GLP ‐1 receptor agonists and SGLT2 inhibitors as adjuncts to insulin in type 1 diabetes: Systematic review and meta‐analysis. Diabetes Obes Metab. Published 28 January 2026. doi:10.
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