Obesity Complicating Type 1 Diabetes: GLP-1 Analogue Anti-obesity Treatment

More than 40% of young adults with type 1 diabetes (T1D) also have overweight or obesity. Each of these diagnoses increase the risk of adverse cardiovascular events. GLP-1 analogues are anti-obesity medications that are cardioprotective in adults with type 2 diabetes, however evaluation of these agents in people with T1D has been limited to glycemic outcomes. Investigators aim to study the impact of GLP-1 analogue obesity treatment on markers of cardiometabolic risk in young adults with T1D and obesity.

Inclusion Criteria: * Age 18-30 years with T1D whose BMI meets FDA approval criteria for anti-obesity pharmacotherapy (BMI ≥30 kg/m2 alone or BMI ≥27 kg/m2 with a weight-related comorbidity) * Clinical diagnosis of T1D * Diabetes duration diagnosed ≥ 12 months ago * HbA1c ≤10% at screening and within the past 90 days * Stable reported insulin dosing in the past 90 days (within 15%) * Stable reported BMI in the past 90 days (within 5%) * Ability to provide written informed consent before any trial-related activities * Use of real-time continuous glucose monitoring and planned continued use * Females and males of childbearing potential willing to use highly effective methods of contraception for at least 1 month prior to randomization and agreement to use such a method during study participation and for 2 months after the last dose of study medication administration: Combined estrogen-progestogen contraception including: oral, intravaginal, transdermal (patch), Progestogen-only contraception: oral, injectable or implantable, Placement of an intrauterine device or intrauterine system, Bilateral tubal occlusion (fallopian tubes are blocked), Male partner sterilization (with the appropriate post-vasectomy documentation of the absence of sperm in the ejaculate), or Complete sexual abstinence from male-female sex) * Stated willingness to comply with all study procedures, medication regimen, and availability for the duration of the study * Participants cannot be randomized if any laboratory safety parameter at screening is outside the below extended laboratory ranges. For randomization, participants should have 1. Creatinine \