Use of GLP-1 Receptor Agonists and SGLT2 Inhibitors Among Patients with Type 1 Diabetes: A Nationwide Register-Based Cohort Study.
In 2024, only 5.5% of patients with type 1 diabetes used GLP-1 receptor agonists, and 0.9% used SGLT2 inhibitors, despite many having poor cardiometabolic control.
Where it sits
this study against the rest of the lixisenatide corpusSummary and findings
This study assessed the use of GLP-1 receptor agonists and SGLT2 inhibitors among patients with type 1 diabetes in Sweden. The study included 72,698 patients aged ≥18 years from 2007 to 2024. In 2024, 5.5% of patients used GLP-1 receptor agonists and 0.9% used SGLT2 inhibitors.
Abstract
<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Findings</h4>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.<h4>Interpretation</h4>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.<h4>Funding</h4>The Swedish Research Council, Swedish Society of Medicine and ALF Region Stockholm.
Background
This paper investigates the use of GLP-1 receptor agonists and SGLT2 inhibitors in patients with type 1 diabetes, a population where these treatments are not yet approved. Prior studies indicated potential benefits of these drugs in managing cardiometabolic risk factors, but safety concerns have hindered their approval. Understanding the current use patterns in a national cohort may inform future research and regulatory decisions.
Methods
The study utilized Swedish nationwide registers to include all patients aged ≥18 years with type 1 diabetes from 2007 to 2024. The primary outcome measures included yearly prevalence of drug use, the proportion of patients with elevated HbA1c or obesity not receiving treatment, and incidence of diabetic ketoacidosis among SGLT2 inhibitor users. The analysis involved 72,698 patients.
Results
In 2024, the prevalence of GLP-1 receptor agonist use was 5.5% (3220/58,564) and SGLT2 inhibitor use was 0.9% (552/58,564). Additionally, 24.5% (14,348/58,564) of patients had an HbA1c of ≥64 mmol/mol (≥8.0%), and 16.8% (9839/58,564) had obesity without treatment. The incidence of diabetic ketoacidosis among first-time SGLT2 inhibitor users was reported as 24.9 (95% CI 18.4-31.5) events per 1000 person-years.
Interpretation
The findings indicate that the use of GLP-1 receptor agonists and SGLT2 inhibitors in type 1 diabetes remains low, despite a significant proportion of patients having suboptimal cardiometabolic risk factors. While the statistical significance of the findings is clear, the clinical relevance may be limited due to the low prevalence of drug use and the potential risks associated with SGLT2 inhibitors. The study's reliance on prescription data and the lack of causal inference are notable confounds that may affect the conclusions drawn.
Key findings
- 5.5% (3220/58,564) of patients used GLP-1 receptor agonists in 2024.
- 0.9% (552/58,564) of patients used SGLT2 inhibitors in 2024.
- 24.5% (14,348/58,564) of patients had HbA1c of ≥64 mmol/mol (≥8.0%) in 2024.
- 16.8% (9839/58,564) of patients had obesity and were not treated with either drug.
- The on-treatment incidence of diabetic ketoacidosis among 1291 first-time SGLT2 inhibitor users was 24.9 (95% CI 18.4-31.5) events per 1000 person-years.
Limitations
- small n=72,698
- observational study design limits causal inference
- low prevalence of drug use may affect generalizability
- data based on prescription fills, not actual adherence
- no long-term follow-up reported