GLP-1 drugs beat metformin at heading off diabetes in large records study
In more than 250,000 adults with prediabetes and obesity, three-quarters of them women, GLP-1 users were less likely to develop Type 2 diabetes or heart problems, but the findings are preliminary.
If you have been told your blood sugar is in the prediabetes range, a new analysis adds data to a conversation many women are already having with their clinicians.
Researchers at Mayo Clinic in Scottsdale, Arizona, used electronic health records from 104 institutions in the TriNetX network to compare 256,492 adults with prediabetes and obesity. Their average age was 52, and 76% were women. About half took a GLP-1 medication such as semaglutide, tirzepatide, liraglutide or dulaglutide; the rest took metformin, the long-standing first choice for diabetes prevention. Patients were matched on age, health conditions and other medications and followed for about three years.
Compared with metformin users, people on GLP-1s were about 1.5 times as likely to see their blood sugar return to normal and had a 31% lower risk of developing Type 2 diabetes. They also had 41% lower risk of death from any cause, 15% fewer heart attacks, 20% fewer strokes and 25% fewer cases of heart failure, according to the American Heart Association, which released the findings Nov. 2 ahead of its Scientific Sessions in Chicago, Nov. 6-9.
The caveats matter. This is an observational study, so it shows association, not cause and effect. It has not been peer-reviewed. The records do not show whether patients took their doses consistently, the drugs were grouped together and the release reports no side effects, cost data or results broken out for women.
This study does not settle which is right for any one person.
GLP-1s remain the subject of real debate over side effects, muscle loss, price and insurance coverage, and metformin is an inexpensive, familiar generic. This study does not settle which is right for any one person.
What to ask your provider: What is my A1C and my actual risk of progressing to diabetes? Am I a candidate for lifestyle changes alone, metformin or a GLP-1? What side effects and costs should I expect, and does my plan, whether Medicare, TRICARE or VA, cover it for prediabetes? How will we protect my muscle mass if I lose weight?
