BACKGROUND: Wide pathological heterogeneity exists in patients with autoimmune diabetes, typically classified as type 1 diabetes (T1D); up to half may have latent autoimmune diabetes in adults (LADA) with slower onset of beta-cell destruction. Second-generation incretin analogs may have potential benefits for these patients.
OBJECTIVES: A systematic review was conducted to assess existing knowledge related to the use of semaglutide or tirzepatide for T1D or LADA treatment.
DATA SOURCES: The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search included Ovid MEDLINE, Cochrane CENTRAL, Embase, CINAHL, Web of Science, and ClinicalTrials.gov for studies published between 1 January 2020 and 12 June 2025 involving adults with T1D or LADA treated with semaglutide or tirzepatide.
CONCLUSIONS: From 3,053 records screened, 11 eligible publications were selected. These included two systematic reviews, one post hoc subgroup analysis, six narrative/consensus reviews, and two LADA case reports. Three themes emerged: (1) Inconsistency and misdiagnosis or diagnostic delay of LADA; (2) Potential benefits of tirzepatide and semaglutide for LADA and certain types of T1D, and; (3) Existing approaches for clinical management. Well-designed, adequately powered randomized trials in clearly defined LADA and T1D populations are needed to clarify long-term efficacy.
IMPLICATIONS FOR PRACTICE: Current evidence for semaglutide and tirzepatide in T1D and LADA is promising but of moderate quality. Diagnosis and management of LADA is challenging, but potential approaches exist. Second-generation incretin analogs may provide multiple benefits for adults with autoimmune diabetes who retain residual beta-cell function.
