Adjunctive pharmacotherapy for obesity in type 1 diabetes: current evidence for GLP-1 receptor agonists

The increasing prevalence of obesity among individuals with type 1 diabetes (T1D) has introduced significant metabolic complexity, including insulin resistance, weight-related comorbidities, and escalating insulin requirements. Traditional insulin-centric management strategies often exacerbate weight gain, highlighting the need for adjunctive pharmacological approaches. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GLP-1/GIP receptor agonist (dual GLP-1/GIP RA), widely used in type 2 diabetes and obesity, offer mechanistic benefits through appetite suppression, delayed gastric emptying, modulation of glucagon secretion, and improvement in insulin sensitivity. This narrative perspective combines a single clinical case report with an overview of the available evidence on GLP-1 RAs and dual GLP-1/GIP RAs as emerging adjunctive therapies for obesity management in T1D. The available evidence, including our clinical experience, is considered in the context of potential benefits, safety considerations, and the current limitations of the evidence base. Given the limited evidence in T1D, further well-designed studies are needed to better define their efficacy/effectiveness, safety, and appropriate clinical use in people with T1D and obesity.