In a large target trial emulation of 174,678 people with type 1 diabetes, GLP-1 receptor agonist initiation was associated with lower risks of major cardiovascular events and end-stage kidney disease over five years. The study also found no increased risk of hospitalization for diabetic ketoacidosis or severe hypoglycemia, supporting further randomized trials of GLP-1RAs as adjunctive therapy in type 1 diabetes.