The Horizon Ahead: Emerging Adjunctive Therapies for Type 1 Diabetes.

This perspective outlines a clinical roadmap for integrating adjunctive metabolic therapies into the care of people with type 1 diabetes. Despite major advances in insulin delivery and technology, cardiometabolic risk, weight gain, and glycemic variability remain significant challenges. We propose an evidence-based approach, which expands beyond insulin alone and highlights a metabolic therapy tree: low-hanging fruit such as incretin-based therapies and amylin analogs; slightly higher fruit including sodium-glucose linked transporter inhibitors unlocked through safety engineering and continuous ketone monitoring; and emerging targets such as glucagon modulation and fibroblast growth factor 21 analogs.