Seetharaman Sujatha, Cengiz Eda
Division of Pediatric Endocrinology & Diabetes, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
J Diabetes Sci Technol. 2025 Mar;19(2):311-320. doi: 10.1177/19322968241309896. Epub 2024 Dec 31.
Type 1 diabetes (T1D) necessitates lifelong insulin therapy due to the autoimmune destruction of insulin-producing pancreatic beta cells. Despite advancements in diabetes technology and insulin formulations, maintaining optimal glycemic outcomes remains challenging in these individuals. Obesity, accompanied by insulin resistance, is common not only in type 2 diabetes (T2D) but also in many individuals with T1D. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs), approved for T2D and obesity, are now being explored for off-label use in individuals with T1D. This review examines their efficacy, safety, and potential benefits in T1D management. We reviewed articles published up to May 2024 from databases like PubMed and Scopus, mainly focusing on human studies of GLP-1 RAs in T1D, as well as cardiorenal and metabolic outcomes in individuals with T2D and obesity. Semaglutide and other GLP-1 RAs showed significant improvements in glycemic outcomes, hemoglobin A levels, reduced insulin doses, and notable weight loss. Studies in individuals with obesity and T2D showed significant improvements in lipid profile and offered cardiorenal protection. Common side effects include gastrointestinal issues, and while some studies reported hypoglycemia, hyperglycemia, and ketosis, others did not. Despite these challenges, GLP-1 RAs offer significant therapeutic benefits, making them a promising adjunct to insulin therapy for improving clinical outcomes in T1D management.
1型糖尿病（T1D）由于产生胰岛素的胰腺β细胞受到自身免疫破坏，需要终身胰岛素治疗。尽管糖尿病技术和胰岛素制剂有所进步，但在这些患者中维持最佳血糖结果仍然具有挑战性。肥胖伴有胰岛素抵抗，不仅在2型糖尿病（T2D）中常见，在许多T1D患者中也很常见。已被批准用于T2D和肥胖症的胰高血糖素样肽-1受体激动剂（GLP-1 RAs），目前正在探索其在T1D患者中的非标签使用。本综述探讨了它们在T1D管理中的疗效、安全性和潜在益处。我们检索了截至2024年5月在PubMed和Scopus等数据库上发表的文章，主要关注GLP-1 RAs在T1D中的人体研究，以及T2D和肥胖症患者的心脏肾脏和代谢结果。司美格鲁肽和其他GLP-1 RAs在血糖结果、血红蛋白A水平、减少胰岛素剂量和显著减重方面显示出显著改善。对肥胖和T2D患者的研究显示血脂谱有显著改善，并提供了心脏肾脏保护。常见的副作用包括胃肠道问题，虽然一些研究报告了低血糖、高血糖和酮症，但其他研究没有。尽管存在这些挑战，GLP-1 RAs提供了显著的治疗益处，使其成为胰岛素治疗的有前途的辅助药物，可改善T1D管理的临床结果。
