S720 Glucagon-Like Peptide 1 Receptor Agonists Reduce All-Cause Mortality and Healthcare Utilization in Patients With Type 1 Diabetes

Introduction: Glucagon-like peptide 1 receptor agonists (GLP-1RAs) are US Food and Drug Administration approved for type 2 diabetes (T2D) and weight loss and are increasingly being used off-label for patients with type 1 diabetes (T1D). We evaluated the risks and healthcare utilization among T1D patients receiving these medications up to 2 years. Methods: We utilized the TriNetX database, a global federated network with data from numerous healthcare organizations. We identified patients with T1D using International Classifications of Diseases, Tenth Revision (ICD-10) codes and excluded those with T2D diagnoses and SGLT-2i use. T1D patients were then divided into 2 cohorts based on whether or not they had received GLP-1RAs. We then performed 1:1 propensity matching for demographics (age, sex, and race), inflammatory bowel disease, body mass index, and HbA1c. Primary outcomes included Emergency Department (ED) visits, hospitalizations, DKA, hypoglycemia, prokinetic prescriptions, and all-cause mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were obtained for all outcomes except all-cause mortality, for which Cox regression analysis was performed to obtain hazard ratio (HR) at 2 years. Index event was defined as meeting inclusion criteria as well as at least 6 months of continuous GLP-1RA use for the respective cohort based on refill documentation. Results: After propensity score matching, 4,760 patients were identified in each group. The matched cohorts were predominantly White (71.9% in GLP-1RA cohort, 71.8% in non-GLP-1RA cohort) and female (62.0% in both). Patients taking GLP-1RAs had lower ED visits (OR 0.46, 95% CI 0.39-0.55, P < 0.001), all-cause admission (OR 0.24, CI 0.17-0.33, P < .001), DKA (OR 0.58, 95% CI 0.36-0.93, P = 0.02), prokinetic use (OR 0.73, CI 0.56-0.95, P = 0.02), and all-cause mortality (HR 0.24, CI 0.16-0.34, P = 0.005). There was no significant difference between groups for hypoglycemia (P = 0.4). Conclusion: Patients with T1D receiving GLP-1RAs had significantly lower ED visits, inpatient admission, DKA, prokinetic prescriptions, and all-cause mortality with no significant effect on hypoglycemia. This data suggests that GLP-1RAs may not only be safe, but also beneficial for patients with T1D, though prospective data are necessary to confirm our conclusions.