Â鶹Éçmadou

People living with type 1 diabetes (T1D) face a significantly higher risk of cardiovascular disease, and despite advances in insulin therapy and glucose monitoring, that risk remains stubbornly elevated. A newly published review in Trends in Endocrinology and Metabolism—led by Dr Ruth Frampton (Garvan Institute of Medical Research; Â鶹Éçmadou; St Vincent’s Hospital Sydney; The Canberra Hospital) and co-authored with Prof Jerry Greenfield, Dr Jennifer Snaith (Garvan Institute; Â鶹Éçmadou; St Vincent’s), and Dr Samantha Hocking (University of Sydney; Charles Perkins Centre; Royal Prince Alfred Hospital)—takes a fresh look at how emerging therapies might help close that gap.

The review, published in Trends in Endocrinology& Metabolilsm, focuses on incretin hormones—GLP-1 and GIP—which play a key role in regulating insulin secretion, glucose metabolism, and appetite. While incretin-based therapies have revolutionised treatment for type 2 diabetes and obesity, their potential in T1D has remained largely unexplored. This paper brings together physiological insights and clinical trial data to examine how these therapies might be repurposed to address the unique metabolic challenges of T1D, including insulin resistance, postprandial hyperglycaemia, and hormonal dysregulation.

What makes this review particularly timely is the growing interest in therapies like semaglutide and tirzepatide, which target GLP-1 and GIP receptors. These agents have shown cardiovascular and renal benefits in other populations, and the authors argue that their mechanisms—such as reducing glycaemic variability and improving insulin sensitivity—could be especially valuable in T1D, where traditional treatment strategies often fall short.

The paper also highlights the need for more targeted research. Questions remain about how these therapies perform in people with residual beta cell function, or in those with obesity—a growing subgroup within the T1D population. The authors call for clinical trials that go beyond glucose metrics to include cardiovascular and renal outcomes, and that reflect the diversity of real-world patients.

This publication exemplifies the collaborative community ethos of the CVMM theme, which brings together researchers across institutions and disciplines to tackle complex cardiometabolic challenges. It’s a compelling example of how rethinking established therapies through a new lens can open up promising avenues for care.

Well done, Ruth, Jennifer, and Jerry!

Potential benefits of incretin-based therapies in people living with type 1 diabetes. (Figure created with BioRender).