New Guidance on Using GLP Drugs for Type 1 Diabetes

Upcoming consensus report addresses safety and optimal use of off-label adjunctive therapy.

Mar. 16, 2026 at 9:26am

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New guidance on the use of GLP-1-based drugs in people with type 1 diabetes (T1D) will address the safety and optimal use of these medications, which are currently used off-label in this patient population. The upcoming Adjunctive Treatment with GLP/GIPs for Patients with T1D: A Consensus Report and Guidelines for Safe Use will be published in June 2026, providing recommendations on starting slow with GLP-1/GIP doses, carefully titrating insulin, monitoring for side effects, and addressing insurance coverage challenges.

Why it matters

The use of GLP-1 drugs in people with T1D has been increasing in recent years, particularly as an adjunct to insulin in those who also have obesity and/or cardiovascular disease. However, the dosing and management requires careful consideration given the differences between T1D and T2D.

The details

The upcoming consensus guidelines will recommend starting GLP-1/GIP doses gradually, as the full dose typically used for T2D may not be as tolerable for those with T1D. Insulin doses will also need to be titrated carefully to avoid hyperglycemia, ketosis, diabetic ketoacidosis, and hypoglycemia, with a typical recommendation to cut insulin by 20%. Baseline labs, monitoring for side effects like GI issues, and assessing for diabetic retinopathy progression will also be advised. The guidelines will address the challenges of insurance coverage for off-label use in T1D, which often requires documentation of insulin resistance, high insulin needs, and hypertriglyceridemia.

  • The Adjunctive Treatment with GLP/GIPs for Patients with T1D: A Consensus Report and Guidelines for Safe Use will be published in the June 2026 issue of the ATTD journal Diabetes Technology and Therapeutics.

The players

Satish K. Garg

Professor of medicine and pediatrics at the Barbara Davis Center for Diabetes, University of Colorado, Denver, and editor-in-chief of Diabetes Technology and Therapeutics.

Francine R. Kaufman

Distinguished Professor Emerita of Pediatrics and Communications, Keck School of Medicine of University of Southern California, Los Angeles.

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What they’re saying

“The usual full dose that is recommended for people with type 2 diabetes, which in the case of tirzepatide goes all the way up to 15 mg weekly, is usually not the most acceptable or tolerable dose [in T1D]. The majority of our patients are able to achieve the target weight and the benefits by 7.5 to 10 mg.”

— Satish K. Garg, Professor of medicine and pediatrics

“This is where [continuous glucose monitoring] is really imperative, and where remote monitoring is important. You're not going to see these patients all the time, but somebody needs to educate them and be sure that the therapy is having a positive effect and no negatives.”

— Francine R. Kaufman, Distinguished Professor Emerita of Pediatrics and Communications

What’s next

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The takeaway

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