Use of GLP-1 Receptor Agonists and SGLT2 Inhibitors Among Patients with Type 1 Diabetes: A Nationwide Register-Based Cohort Study.

Abstract

GLP-1 receptor agonists and SGLT2 inhibitors improve cardiometabolic risk factors in type 1 diabetes, but lack approval, partly due to safety concerns. We aimed to assess the use of these drugs in a national population of patients with type 1 diabetes. Using Swedish nationwide registers, we included all patients aged ≥18 years with type 1 diabetes, 2007-2024. We calculated yearly prevalence of GLP-1 receptor agonist and SGLT2 inhibitor use based on prescription fills; the proportion of patients with elevated HbA1c or obesity, without receiving any of the drugs; and diabetic ketoacidosis incidence among SGLT2 inhibitor users. 72,698 patients were included (median (IQR) age in 2024: 48 (33, 63) years). Use of the drugs increased during the study period and reached 5.5% (3220/58,564) in 2024 for GLP-1 receptor agonists and 0.9% (552/58,564) for SGLT2 inhibitors (peak in 2022: 1.1% [610/55,949]). In 2024, 24.5% (14,348/58,564) of patients had HbA1c of ≥64 mmol/mol (≥8.0%) and 16.8% (9839/58,564) had obesity and were not treated with either drug. Among 1291 first-time SGLT2 inhibitor users, the on-treatment incidence of diabetic ketoacidosis was 24.9 (95% CI 18.4-31.5) events per 1000 person-years. Use of GLP-1 receptor agonists and SGLT2 inhibitors in type 1 diabetes remained low (5.5% and 0.9% in 2024), with many untreated patients having suboptimal cardiometabolic risk factors. While ancillary treatment could potentially improve outcomes, regulatory approval is lacking and further research on the risk-benefit balance across clinically relevant subgroups would help inform potential expansion of use. The Swedish Research Council, Swedish Society of Medicine and ALF Region Stockholm.