D1, unfortunately, doesn't support loading extensions into SQLite.
fly.io, and their sqlite solution, does however!
I've been using fly.io to run cr-sqlite in the cloud and act as a sync server for non peer to peer use cases. Eventually I'll have finished up a re-write of strut.io[1] atop vlcn/cr-sqlite which'll serve as a good end to end example of how to make applications with this sort of architecture.
Some discussion about this setup on the fly.io forums: https://community.fly.io/t/litefs-many-tens-to-hundreds-of-t...
It's basically an offline-first flashcard webapp. CR-Sqlite allows for incremental syncing.
With Anki (the app from which I'm taking my inspiration), syncing is _not_ incremental - basically it just copies SQLite files around. So for example, the app could be on an iPhone with cards a card `A` reviewed, but the app on an iPad could make changes to the template on which card `A` is based, and that's enough to cause a conflict - you must take changes from only the iPad or only the iPhone. (To be clear - Anki does have some incremental syncing capabilities - I'm picking an intentionally pathological example.) CR-SQLite will mean that everything is incremental, however.
Basically makes 3 way merges a breeze (or n-way merges, really).