Obesità e terapie incretiniche nel diabete di tipo 1: razionale ed evidenze su GLP-1RA e tirzepatide

Overweight, obesity and insulin resistance are increasingly common in type 1 diabetes and contribute to a high-risk double-diabetes phenotype. GLP-1 receptor agonists and tirzepatide reduce body weight and insulin requirements, with emerging improvements in HbA1c and time in range, including during Automated Insulin Delivery. The evidence has been strengthened by randomised studies of semaglutide and tirzepatide, but remains limited by small samples and short follow-up. Gastrointestinal intolerance, hypoglycaemia, ketosis and inappropriate insulin reduction remain central concerns; these agents cannot yet be considered routine adjunctive therapy for type 1 diabetes.