Management of Type 1 Diabetes

Standard of Care

The American Diabetes Association recommends insulin replacement as the mainstay of therapy for type 1 diabetes, typically through multiple daily injections of prandial and basal insulin or continuous subcutaneous insulin infusion via insulin pump 1, 2
Insulin analogs are preferred over human insulins to minimize hypoglycemia risk, as recommended by the American Diabetes Association 1, 2
Proper insulin management should include education on matching prandial insulin to carbohydrate intake, adjusting for premeal blood glucose levels, and accounting for anticipated physical activity, according to the American Diabetes Association 1

The American College of Physicians notes that pramlintide is the only FDA-approved non-insulin adjunctive therapy for type 1 diabetes, which functions as an amylin analog that delays gastric emptying, blunts glucagon secretion, and enhances satiety 3
When using pramlintide, the American College of Physicians recommends reducing prandial insulin dosing to minimize hypoglycemia risk 3

The American Association of Clinical Endocrinologists states that metformin may reduce insulin requirements but does not significantly improve HbA1c in type 1 diabetes patients 3, 4
The Endocrine Society notes that GLP-1 receptor agonists, such as liraglutide, showed some benefit but increased risk of hypoglycemia and ketosis in type 1 diabetes patients 4, 5
The American Diabetes Association reports that SGLT-2 inhibitors provide insulin-independent glucose lowering but increase risk of euglycemic diabetic ketoacidosis in type 1 diabetes patients 3, 4

Tirzepatide may have effects on other pancreatic hormones like glucagon in type 1 diabetes patients 6

Tirzepatide may reduce insulin requirements, promote weight loss, and improve glycemic control in type 1 diabetes patients 7
There is a potential increased risk of diabetic ketoacidosis (DKA) associated with tirzepatide use in type 1 diabetes patients 8

The American Diabetes Association acknowledges that GLP-1 receptor agonists, such as tirzepatide, show modest A1C reductions, weight decreases, and reductions in insulin doses in type 1 diabetes patients 7
Close monitoring for ketosis and DKA is essential for patients with type 1 diabetes considering tirzepatide 8
Insulin remains the cornerstone of therapy for type 1 diabetes, as tirzepatide cannot replace insulin therapy 9

Until more evidence is available, tirzepatide use in type 1 diabetes should be considered experimental and used with caution 6, 7