OBJECTIVE: Review available data on adjunctive therapies for type 1 diabetes 
(T1D), with a special focus on newer antihyperglycemic agents.
METHODS: Published data on hypoglycemia, obesity, mortality, and goal attainment 
in T1D were reviewed to determine unmet therapeutic needs. PubMed databases and 
abstracts from recent diabetes meetings were searched using the term "type 1 
diabetes" and the available and investigational sodium-glucose cotransporter 
(SGLT) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, dipeptidyl 
peptidase 4 inhibitors, and metformin.
RESULTS: The majority of patients with T1D do not meet glycated hemoglobin (A1C) 
goals established by major diabetes organizations. Hypoglycemia risks and a 
rising incidence of obesity and metabolic syndrome featured in the T1D 
population limit optimal use of intensive insulin therapy. Noninsulin 
antihyperglycemic agents may enable T1D patients to achieve target A1C levels 
using lower insulin doses, which may reduce the risk of hypoglycemia. In pilot 
studies, the SGLT2 inhibitor dapagliflozin and the GLP-1 receptor agonist 
liraglutide reduced blood glucose, weight, and insulin dose in patients with 
T1D. Phase 2 studies with the SGLT2 inhibitor empagliflozin and the dual SGLT1 
and SGLT2 inhibitor sotagliflozin, which acts in the gut and the kidney, have 
demonstrated reductions in A1C, weight, and glucose variability without an 
increased incidence of hypoglycemia.
CONCLUSION: Newer antihyperglycemic agents, particularly GLP-1 agonists, SGLT2 
inhibitors, and dual SGLT1 and SGLT2 inhibitors, show promise as adjunctive 
treatment for T1D that may help patients achieve better glucose control without 
weight gain or increased hypoglycemia.