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Meta-Analysis
. 2025 Aug 7:16:1550938.
doi: 10.3389/fendo.2025.1550938. eCollection 2025.

The effects of GLP-1 agonists on HbA1c and insulin dose among patients with type 1 diabetes

Amirah Alhowiti  1 , Hyder Mirghani  2
Affiliations
Meta-Analysis

The effects of GLP-1 agonists on HbA1c and insulin dose among patients with type 1 diabetes

Amirah Alhowiti et al. Front Endocrinol (Lausanne). .

Abstract

Type 1 diabetes mellitus (T1DM) is a common chronic disease, and there is a rising trend globally; insulin is the mainstay therapy. Despite improvements in insulin delivery and monitoring, a significant percentage of patients still fail to reach glycemic targets. There is an increasing interest in using glucagon-like receptor agonists as adjuvant therapy. A high risk of bias limits meta-analysis on the effectiveness of GLP-1 agonists. This meta-analysis aimed to assess the effects of GLP-1 agonists on HbA1c and total daily insulin dose in T1DM. We searched PubMed, Cochrane Library, and Google Scholar for articles investigating the effects of GLP-1 agonists on the HbA1c and total daily insulin dose without limitation to the publication date. The keywords used were GLP-1 agonists, liraglutide, albiglutide, exenatide, glycated hemoglobin, HbA1c, insulin dose, and glycemic control. Out of the 713 articles retrieved, 21 full texts were screened, and 10 trials were included in the meta-analysis. GLP-1 agonists are more effective than placebo in HbA1c reduction, Z = 5.27, SMD, 0.23, 95% confidence interval (CI), 0.14-0.32, with 1.2 mg and 1.8 mg more effective than 0.6 mg, SMD, -0.87, 95% CI, -1.60 to 0.13, and SMD, -0.79, 95% CI, -1.18 to 0.41, respectively. GLP-1 agonists reduce total daily insulin dose SMD, 2.21, 95% CI, 0.43-3.98 with no significant differences between different doses. GLP-1 agonists were effective in HbA1c and total daily insulin reduction among patients with T1DM. Liraglutide 1.2 mg may be more beneficial; further randomized trials focusing on different doses of GLP-1 agonists and hypoglycemia risk are recommended.

Keywords: HbA1c; glucagon-like peptide agonists; insulin dose; insulin reduction; type 1 diabetes.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Literature search to retrieve articles assessing the effects of GLP-1 agonists on HbA1c, and insulin dose among patients with type 1 diabetes. (The PRISMA chart).
Figure 2
Figure 2
(A) HbA1c reduction following GLP-1 agonists among patients with type 1 diabetes mellitus forest plot. (B) HbA1c reduction following GLP-1 agonists among patients with type 1 diabetes mellitus Funnel plot.
Figure 3
Figure 3
Liraglutide 0.6 mg versus 1.2 mg effects on HbA1c.
Figure 4
Figure 4
Liraglutide 0.6 mg versus 1.8 mg effects on HbA1c.
Figure 5
Figure 5
Liraglutide 1.2 mg versus 1.8 mg effects on HbA1c.
Figure 6
Figure 6
(A) Insulin dose following GLP-1 agonists among patients with type 1 diabetes mellitus forest plot. (B) Insulin dose following GLP-1 agonists among patients with type 1 diabetes mellitus Funnel plot.
Figure 7
Figure 7
Liraglutide 0.6 mg versus 1.2 mg effects on total insulin dose.
Figure 8
Figure 8
Liraglutide 0.6 mg versus 1.8 mg effects on total insulin dose.
See this image and copyright information in PMC

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