Efficacy and Safety of GLP-1 Receptor Agonists as Add-On Therapy to Insulin-Based Regimens in Adults with Type 1 Diabetes: A Systematic Review and Meta-Analysis

Introduction and Objective: Adjunctive glucagon-like peptide 1 (GLP-1) receptor agonist therapy has been studied in adults with type 1 diabetes, but its efficacy and safety remain uncertain. We conducted a meta-analysis to evaluate GLP-1 receptor agonists as add-on therapy to insulin-based regimens in adults with type 1 diabetes. Methods: PubMed, Scopus, Embase, and the Cochrane Library were searched for studies comparing GLP-1 receptor agonists with standard of care in adults with type 1 diabetes. The primary outcome was change in glycated hemoglobin (HbA1c). Secondary outcomes included body weight, hypoglycemia, diabetic ketoacidosis, and total daily insulin dose. Random-effects model was used. Results: 31 studies, including 2,589 participants were analyzed. Adjunctive GLP-1 receptor agonist therapy was associated with a significant reduction in HbA1c compared with insulin based therapy alone (MD −0.32%, 95% CI −0.40 to −0.24). Significant reductions were also observed in body weight (MD −6.51 kg, 95% CI−8.48 to−4.54) and total daily insulin dose (MD−4.82 U/day, 95% CI −5.54 to −4.11). There was no increased risk of hypoglycemia or diabetic ketoacidosis (RR 0.70). Conclusion: In adults with type 1 diabetes, adjunctive GLP-1 receptor agonist therapy was associated with improved glycemic control, reduced body weight, and lower insulin requirements, without increased risk of hypoglycemia or diabetic ketoacidosis. Disclosure: J.M. Zaldumbide: None. E.M. Mogrovejo: None. M.S. Hinojosa: None. D.E. Egas: None. E.A. Nuñez: None. M.S. Guadalupe: None.