Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are being evaluated for potential roles beyond glycemic control in type 1 diabetes mellitus (T1DM). A retrospective cohort analysis presented at the AACE Annual Meeting 2026 assessed whether GLP-1RA use is associated with differences in microvascular and macrovascular outcomes in patients with T1DM.

The analysis used the TriNetX platform and included 133,782 patients with T1DM who received GLP-1RAs and 985,724 who did not. Propensity score matching for age, ethnicity, body mass index, and hemoglobin A1c produced two balanced cohorts of 130,453 patients each. Outcomes included renal complications, diabetic retinopathy, diabetic neuropathy, and atherosclerotic disease. Events occurring at least 1 year after the index event were assessed, and patients with prior outcomes were excluded.

GLP-1RA use was associated with lower risk of renal complications (RD 0.011; 95% CI 0.010 to 0.012; P=0.000), diabetic retinopathy (RD 0.003; 95% CI 0.002 to 0.004; P=0.000), diabetic neuropathy (RD 0.006; 95% CI 0.005 to 0.007; P=0.000), and atherosclerotic disease (RD 0.018; 95% CI 0.015 to 0.020; P=0.000).

Insulin remains the standard therapy for T1DM. These findings indicate that GLP-1RA use was associated with a lower risk of microvascular and macrovascular complications, suggesting a potential role as an adjunct in selected patients. These findings are based on observational data and require confirmation in prospective studies and randomized clinical trials.