The analogues of GLP-1 (AGLP-1) and the SGLT2 inhibitors, indicated in type 2 diabetes (DT2), will they arrive in type 1 diabetes (DT1)? While observation data show their interest in type 1 for glycemic control, weight loss, cardio- and nephroprotection, these drugs are already prescribed, excluding marketing indication.
“In practice, patients initially DT1 are offered AGLP-1, this is a great topical subject in response to the’increase in overweight and obesity in type 1 diabetesmore and more observed in young peopletestifies to Daily Pr Éric Renard, President of the French -speaking Société du Diabetes (SFD) and head of the endocrinology and diabetology department at the Montpellier CHU. This is less true for ISGLT2, which include a high risk of acidocetosis, even if they are sometimes prescribed. »»
In the United States, around a third of DT1 patients are under AGLP-1, especially because of overweight and obesity
Pr Éric Renard, President of the French -speaking Diabetes Society
Double diabetes
According to Professor, DT1 has a shift to DT2. “We meet more and more DT1 patients with overweight or obesity and DT2 characteristics, such as insulin resistance, explains the president of the SFD. We call it double diabetes. »» Thus, for these patients, without predominance of sex or age, the molecules indicated in the DT2 are of interest in type 1. “In the United States, around a third of DT1 patients are under AGLP-1, especially because of overweight and obesity”he completes.
In Europe and the United States, learned companies are working on the introduction of the concept of double diabetes in their recommendations
For the endocrino-diabetologist, the improvement of insulinotherapies contributes to bringing out the phenomenon. Previously, poor glycemic controls have been attributed to insufficient performance of treatments rather than at the existence of mixed diabetes. “But the arrival of new very effective insulinotherapy shows that the problem remains and that uncontrolled patients do not suffer from a diabetes strictly DT1”, he analyzes. The learned companies of diabetes, the United States (ADA) and Europe (EASD), are currently working on the introduction of the concept of double diabetes in their next recommendations. A deconstruction of current nosology profitable for the therapeutic management of patients with diabetes (s).
Recent works (1) presented at the ADA 2025 congress showed the effectiveness of the semaglutide in patients with obese under closed loop. The semaglutide by adjuvant has enabled 36 % of the Sémaglutide group to reach the main composite criterion (more than 70 % of the time spent in the glycemic target 70-180 mg/dl and less than 4 % of the time spent with a blood sugar <70 mg/dl) against 0 % in the placebo group. “This study demonstrates what we already know in practice, comments Prinard. AGLP-1 treatment allows better control of diabetes and improves insulin response. In addition, it allows weight loss in overweight or obesity subjects. »»
Finally, a narrative review (2), reports a benefit of semaglutide and shooting in DT1 patients on glycemic control, weight loss, energy metabolism or the function of beta cells. With regard to undesirable effects, their proportion and nature are similar to those observed for obese or DT2 patients. “In summary, there does not seem to be an obstacle to the introduction of AGLP-1 among the DT1 for these issues”estimates Pré Éric Renard.
Hope with ketones sensors
For ISLGT2, reflection is more complex due to the risk of acidocetosis. However, cardio- and nephroprotection are found in DT1 patients with preexisting cardiac or renal pathology. “” The ISGLT2 are very effective and provide additional benefit from current therapies for these patients, but we must remain very careful and discuss them between specialists ”, warns the endocrino-diabetologist.
Tritherapy including an ISLGT2, a non-steroidal anti-aldosterone and an inhibitor of the conversion enzyme would be very interesting, according to the specialist. Therapeutic education on the risk of acidocetosis is essential, as well as good self -management of the disease. As such, “The imminent arrival of ketones” sensors “ could change things. In addition, some studies evaluating an ISGLT2 by adjuvant to insulin in the patient DT1 without cardio- or nephropathy show an interest in glycemic control in adults and even the adolescent (3). “The rational also exists for the ISGLT2, but recommendations are still premature”concludes Pré Éric Renard.
(1) vn shah et al., Nejm evidence 2025.
Two: 10.1056/Evidoa2500173
(2) M. Infante et al., Journal of Clinical Medicine.
Two: 10.3390/JCM14041303
(3) F.H. Mahmud et al., Nature Medicine 2025.
Two: 10.1038/S41591-025-03723-6