Combination of Glucagon-like Peptide-1 Receptor Agonists and Sodium–Glucose Cotransporter Inhibitors in Type 1 Diabetes: Why, when and How? An Exploration of the Rationale and Clinical Scenarios for Combining These 2 Adjunctive Agents

Husam Ghanim; Sambasiva Rao Srungavarapu; Paresh Dandona; Ajay Chaudhuri

doi:10.1016/j.ecl.2026.04.009

Combination of Glucagon-like Peptide-1 Receptor Agonists and Sodium–Glucose Cotransporter Inhibitors in Type 1 Diabetes: Why, when and How? An Exploration of the Rationale and Clinical Scenarios for Combining These 2 Adjunctive Agents

Husam Ghanim
, Sambasiva Rao Srungavarapu
, Paresh Dandona
, Ajay Chaudhuri

Medicine

SUNY Buffalo

Research output: Contribution to journal › Review article › peer-review

Abstract

Even with the most advanced insulin preparations and delivery systems currently available, it is challenging for many people with type 1 diabetes (T1D) to achieve target levels of glycemic management. Adjunct therapy in T1D consists of adding glucose-lowering agents besides insulin with the aim of lowering hemoglobin A1c (HbA1c) and improving other health outcomes, including weight. It is an attractive potential strategy for achieving glycemic targets and other benefits in this T1D subpopulation. While not yet Food and Drug Adminstration (FDA)-approved for this use, incretin-based therapies (glucagon-like peptide-1 receptor agonist–based therapy) and sodium–glucose cotransporter-1/2 (SGLT-1/2) inhibitors are being prescribed off-label for T1D.

Original language	English
Pages (from-to)	547-561
Number of pages	15
Journal	Endocrinology and Metabolism Clinics of North America
Volume	55
Issue number	3
DOIs	https://doi.org/10.1016/j.ecl.2026.04.009
State	Published - Sep 2026

Keywords

Cardiorenal protection
Combination adjunct therapy
GLP-1RA
SGLT-2 inhibitors

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Ghanim, H., Srungavarapu, S. R., Dandona, P., & Chaudhuri, A. (2026). Combination of Glucagon-like Peptide-1 Receptor Agonists and Sodium–Glucose Cotransporter Inhibitors in Type 1 Diabetes: Why, when and How? An Exploration of the Rationale and Clinical Scenarios for Combining These 2 Adjunctive Agents. Endocrinology and Metabolism Clinics of North America, 55(3), 547-561. https://doi.org/10.1016/j.ecl.2026.04.009

Ghanim, Husam ; Srungavarapu, Sambasiva Rao ; Dandona, Paresh et al. / Combination of Glucagon-like Peptide-1 Receptor Agonists and Sodium–Glucose Cotransporter Inhibitors in Type 1 Diabetes : Why, when and How? An Exploration of the Rationale and Clinical Scenarios for Combining These 2 Adjunctive Agents. In: Endocrinology and Metabolism Clinics of North America. 2026 ; Vol. 55, No. 3. pp. 547-561.

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title = "Combination of Glucagon-like Peptide-1 Receptor Agonists and Sodium{\textendash}Glucose Cotransporter Inhibitors in Type 1 Diabetes: Why, when and How? An Exploration of the Rationale and Clinical Scenarios for Combining These 2 Adjunctive Agents",

abstract = "Even with the most advanced insulin preparations and delivery systems currently available, it is challenging for many people with type 1 diabetes (T1D) to achieve target levels of glycemic management. Adjunct therapy in T1D consists of adding glucose-lowering agents besides insulin with the aim of lowering hemoglobin A1c (HbA1c) and improving other health outcomes, including weight. It is an attractive potential strategy for achieving glycemic targets and other benefits in this T1D subpopulation. While not yet Food and Drug Adminstration (FDA)-approved for this use, incretin-based therapies (glucagon-like peptide-1 receptor agonist{\textendash}based therapy) and sodium{\textendash}glucose cotransporter-1/2 (SGLT-1/2) inhibitors are being prescribed off-label for T1D.",

keywords = "Cardiorenal protection, Combination adjunct therapy, GLP-1RA, SGLT-2 inhibitors",

author = "Husam Ghanim and Srungavarapu, \{Sambasiva Rao\} and Paresh Dandona and Ajay Chaudhuri",

note = "Publisher Copyright: {\textcopyright} 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.",

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language = "English",

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Ghanim, H, Srungavarapu, SR, Dandona, P & Chaudhuri, A 2026, 'Combination of Glucagon-like Peptide-1 Receptor Agonists and Sodium–Glucose Cotransporter Inhibitors in Type 1 Diabetes: Why, when and How? An Exploration of the Rationale and Clinical Scenarios for Combining These 2 Adjunctive Agents', Endocrinology and Metabolism Clinics of North America, vol. 55, no. 3, pp. 547-561. https://doi.org/10.1016/j.ecl.2026.04.009

Combination of Glucagon-like Peptide-1 Receptor Agonists and Sodium–Glucose Cotransporter Inhibitors in Type 1 Diabetes: Why, when and How? An Exploration of the Rationale and Clinical Scenarios for Combining These 2 Adjunctive Agents. / Ghanim, Husam; Srungavarapu, Sambasiva Rao; Dandona, Paresh et al.
In: Endocrinology and Metabolism Clinics of North America, Vol. 55, No. 3, 09.2026, p. 547-561.

Research output: Contribution to journal › Review article › peer-review

TY - JOUR

T1 - Combination of Glucagon-like Peptide-1 Receptor Agonists and Sodium–Glucose Cotransporter Inhibitors in Type 1 Diabetes

T2 - Why, when and How? An Exploration of the Rationale and Clinical Scenarios for Combining These 2 Adjunctive Agents

AU - Ghanim, Husam

AU - Srungavarapu, Sambasiva Rao

AU - Dandona, Paresh

AU - Chaudhuri, Ajay

PY - 2026/9

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N2 - Even with the most advanced insulin preparations and delivery systems currently available, it is challenging for many people with type 1 diabetes (T1D) to achieve target levels of glycemic management. Adjunct therapy in T1D consists of adding glucose-lowering agents besides insulin with the aim of lowering hemoglobin A1c (HbA1c) and improving other health outcomes, including weight. It is an attractive potential strategy for achieving glycemic targets and other benefits in this T1D subpopulation. While not yet Food and Drug Adminstration (FDA)-approved for this use, incretin-based therapies (glucagon-like peptide-1 receptor agonist–based therapy) and sodium–glucose cotransporter-1/2 (SGLT-1/2) inhibitors are being prescribed off-label for T1D.

AB - Even with the most advanced insulin preparations and delivery systems currently available, it is challenging for many people with type 1 diabetes (T1D) to achieve target levels of glycemic management. Adjunct therapy in T1D consists of adding glucose-lowering agents besides insulin with the aim of lowering hemoglobin A1c (HbA1c) and improving other health outcomes, including weight. It is an attractive potential strategy for achieving glycemic targets and other benefits in this T1D subpopulation. While not yet Food and Drug Adminstration (FDA)-approved for this use, incretin-based therapies (glucagon-like peptide-1 receptor agonist–based therapy) and sodium–glucose cotransporter-1/2 (SGLT-1/2) inhibitors are being prescribed off-label for T1D.

KW - Cardiorenal protection

KW - Combination adjunct therapy

KW - GLP-1RA

KW - SGLT-2 inhibitors

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DO - 10.1016/j.ecl.2026.04.009

M3 - Review article

AN - SCOPUS:105040540396

SN - 0889-8529

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JO - Endocrinology and Metabolism Clinics of North America

JF - Endocrinology and Metabolism Clinics of North America

IS - 3

ER -

Ghanim H, Srungavarapu SR, Dandona P , Chaudhuri A. Combination of Glucagon-like Peptide-1 Receptor Agonists and Sodium–Glucose Cotransporter Inhibitors in Type 1 Diabetes: Why, when and How? An Exploration of the Rationale and Clinical Scenarios for Combining These 2 Adjunctive Agents. Endocrinology and Metabolism Clinics of North America. 2026 Sep;55(3):547-561. doi: 10.1016/j.ecl.2026.04.009

Combination of Glucagon-like Peptide-1 Receptor Agonists and Sodium–Glucose Cotransporter Inhibitors in Type 1 Diabetes: Why, when and How? An Exploration of the Rationale and Clinical Scenarios for Combining These 2 Adjunctive Agents

Abstract

Keywords

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