MON-558 - Evaluating the Effect of GLP-1 Receptor Agonists as Add-On Therapy on Glycemic Control and Continuous Glucose Monitoring Outcomes in Adults with Type 1 Diabetes: A Two-Year Real-world Data Study

Background: Achieving optimal glycemic control in type 1 diabetes (T1D) remains challenging due to glycemic variability (GV) and the limitations of insulin therapy. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have emerged as potential adjunctive therapies, but their impact on continuous glucose monitoring (CGM)-derived metrics remains unclear. This study aimed to evaluate the long-term efficacy of GLP-1RAs as an adjunct to insulin therapy in T1D, focusing on CGM-based glycemic outcomes and exploring secondary outcomes (weight and metabolic data).

Methods: This retrospective chart review was conducted on adults with T1D using intensive insulin therapy who initiated GLP-1RAs and maintained treatment for two years. Glycemic and metabolic parameters were assessed at baseline (prior to initiation of GLP-1RAs therapy), one year (T12), and two years (T24) while on combination therapy.

Results: Among 67 participants (56.7% male, mean age: 31.8 years, diabetes duration: 16.6 years, mean HbA1c: 8.24%), GLP-1RA therapy led to a significant increase in %TIR70–180 from 46% (baseline) to 71% (T24) (p < 0.001), and %TTIR70-140 from 28.1% to 47.9% (T24) (p < 0.001). Simultaneously, GRI and its components, CHypo and CHyper, showed sustained reductions, indicating a lower overall glycemic risk. GV improved significantly, with CV% decreasing from 46.3% to 33.6% (p < 0.001). HbA1c improved from 8.2% at baseline to 7.1% (T24), while Total Daily Dose (of insulin) significantly declined from 1.4 IU/kg/day to 0.7 IU/kg/day (all p< 0.001), reflecting an insulin-sparing effect. Body weight decreased from 86 kg at baseline to 72 kg (T24). Additionally, lipid profile improved, including significant reductions in LDL (2.7 to 1.85 mmol/L,( p< 0.001) and Triglycerides (1.6 to 1.24 mmol/L, p< 0.05). Importantly, no participants required hospitalization due to DKA during the study period, and short discontinuation had no significant impact on metabolic or glycemic outcomes.

Conclusions: GLP-1RAs improve glycemic stability and metabolic outcomes in T1D without increasing hypoglycemia risk, supporting their potential use as adjunctive therapy. Future research should explore patient-specific responses, long-term safety, and cardiovascular outcomes.

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