Evidence on cardiovascular and renal outcomes associated with glucagon-like peptide-1 (GLP-1)-based therapies in type 1 diabetes mllitus (T1DM) remains limited. A retrospective cohort study published in the Diabetes, Obesity and Metabolism evaluated cardiovascular, renal, hospitalization, and safety outcomes associated with GLP-1-based therapy in adults with T1DM. 

The analysis used the TriNetX global health research network and included adults with T1DM exposed to GLP-1-based therapies compared with matched individuals not receiving these agents. After 1:1 propensity score matching, 4,088 individuals were included in each group. Outcomes included all-cause mortality, myocardial infarction (MI), cerebral infarction, heart failure (HF), adapted major adverse cardiovascular events (MACE), chronic kidney disease (CKD), all-cause hospitalization, diabetic ketoacidosis (DKA), and hypoglycemia. Event accrual began 6 months after therapy initiation. 

GLP-1-based therapy was associated with lower risks of all-cause mortality (hazard ratio [HR] 0.67; 95% confidence interval [CI], 0.46-0.98), HF (HR 0.38; 95% CI, 0.21-0.67), adapted-MACE (HR 0.61; 95% CI, 0.40-0.94), and all-cause hospitalization (HR 0.70; 95% CI, 0.51-0.96). No significant differences were observed for MI, ischemic stroke, or CKD. 

DKA incidence was not increased with GLP-1-based therapy, while hypoglycemia risk was lower compared with matched controls (HR 0.72; 95% CI, 0.55-0.95). Fewer than 10 pancreatitis events occurred in each group. 

Overall, GLP-1-based therapy in adults with T1D was associated with lower risks of mortality, HF, adapted-MACE, hospitalization, and hypoglycemia without increased DKA risk. Randomized controlled trials are needed to confirm these findings.