Matthew Budoff, MD, discusses the rising prevalence of obesity in type 1 diabetes (T1D) and its cardiovascular implications, emphasizing the need for a treatment paradigm shift to address obesity and cardiometabolic complications. New therapies like SGLT 1/2 inhibitors and GLP-1 receptor agonists show promise, with GLP-1 agonists offering significant benefits in weight reduction and cardiovascular risk mitigation. Early use of calcium scoring or CT angiography is recommended to identify subclinical atherosclerosis. Budoff highlights GLP-1 receptor agonists as a game-changing therapeutic class addressing obesity, diabetes, and cardiovascular health.