{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T17:23:15Z","timestamp":1789147395677,"version":"build-2803163510"},"reference-count":122,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T00:00:00Z","timestamp":1769558400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Adjunctive therapies to insulin for type 1 diabetes mellitus (T1DM), including glucagon\u2010like peptide\u20101 receptor agonists (GLP\u20101RAs) and sodium\u2013glucose cotransporter\u20102 inhibitors (SGLT2is), may improve glycaemic control and reduce insulin requirements; however, safety concerns remain, particularly for diabetic ketoacidosis (DKA).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>PubMed, Ovid MEDLINE, Embase, Web of Science, Scopus and the Cochrane Library through 26 September 2025. Data were pooled using a random\u2010effects model. Risk of bias analyses were performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Ninety studies met inclusion criteria. GLP\u20101RAs produced modest improvements in glycaemic control, lowering glycated haemoglobin (HbA1c) (\u22120.56%) and increasing time\u2010in\u2010range (TIR), while reducing total and basal daily insulin requirements, body weight (\u22123.6\u2009kg) and body mass index (BMI) (\u22121.05\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). Severe hypoglycaemia and DKA were rare; gastrointestinal adverse effects were the most common adverse effects; renal and cardiovascular outcomes were neutral. SGLT2is significantly improved HbA1c (\u22120.38%), TIR (+8.6\u2009pp), insulin requirements (\u22124.7\u2009U\/day), body weight (\u22122.5\u2009kg) and BMI (\u22120.82\u2009kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ). Severe hypoglycaemia was uncommon, while DKA risk was increased (risk ratios\u2009=\u20092.19, 95% confidence interval 1.16\u20134.17), primarily in predictable clinical settings. Renal parameters remained stable or improved, and cardiovascular events were infrequent. Across drug classes, mortality and hospitalisations were rare.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adjunctive GLP\u20101RAs and SGLT2is provide modest clinical improvements in adults with type 1 diabetes. These benefits must be balanced against class\u2010specific safety concerns, especially the increased risk of DKA with SGLT2\u2010based therapies. Larger, long\u2010term trials are needed to define their optimal use in routine care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.70506","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T03:19:47Z","timestamp":1769656787000},"page":"3165-3181","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Efficacy and safety of\n                    <scp>GLP<\/scp>\n                    \u20101 receptor agonists and\n                    <scp>SGLT2<\/scp>\n                    inhibitors as adjuncts to insulin in type 1 diabetes: Systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-1980-7749","authenticated-orcid":false,"given":"Sama M.","family":"Abdel\u2010Rahman","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rama","family":"Al\u2010Shiab","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ermeena","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"G\u00fcldan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmet Bahad\u0131r","family":"Ak","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep Y.","family":"Yilmaz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derya G\u00f6ksu","family":"Fidan","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lasin","family":"Ozbek","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Nephrology Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1297-0675","authenticated-orcid":false,"given":"Mehmet","family":"Kanbay","sequence":"additional","affiliation":[{"name":"Department of Medicine Koc University School of Medicine  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31320-5"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.26.6.1902"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.13129"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-1730"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-2316"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc16-0691"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(17)30308-X"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc18-0623"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1708337"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-0843"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcd.2023.10.010"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"key":"e_1_2_11_15_1","unstructured":"WellsGA SheaB O'ConnellD et al.The Newcastle\u2013Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta\u2010analyses Ottawa. 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