ArticleThe Lancet regional health. Europe2026
Use of GLP-1 Receptor Agonists and SGLT2 Inhibitors Among Patients with Type 1 Diabetes: A Nationwide Register-Based Cohort Study.
Article in The Lancet regional health. Europe, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: 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. Methods: 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. Findings: 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. Interpretation: 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. Funding: The Swedish Research Council, Swedish Society of Medicine and ALF Region Stockholm.
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