GLP-1-based medications, commonly used for weight loss, may significantly reduce the risk of prediabetes progressing to type 2 diabetes and lower the risk of death, according to findings from a large observational study. The study, which analyzed health records of over 256,000 adults with prediabetes and obesity, found that those taking GLP-1 medications experienced a 31% lower risk of developing type 2 diabetes and a 41% lower risk of death compared to individuals taking metformin.
These findings are set to be presented at the American Heart Association’s Scientific Sessions 2026. Metformin is a widely used oral medication for type 2 diabetes and is sometimes prescribed to individuals with prediabetes to help delay or prevent its progression, often in conjunction with lifestyle changes.
The study, which had a three-year follow-up period, also indicated that GLP-1 medications were associated with a 20% reduction in strokes, a 15% decrease in heart attacks, and a 25% lower incidence of heart failure among participants.
Vinicius de Sousa Barzon Serra, M.D., a research fellow at the Mayo Clinic in Scottsdale, Arizona, and the study's author, expressed surprise at the 41% lower risk of death from any cause. He noted that while GLP-1 medications are known for promoting weight loss, their broad benefits across various cardiovascular outcomes, including heart attack, stroke, and atrial fibrillation, were striking.
Prediabetes affects nearly 40% of U.S. adults, characterized by blood sugar levels that are higher than normal but not yet high enough for a diabetes diagnosis. Approximately 10% of individuals with prediabetes can develop type 2 diabetes annually.
Serra suggested that the prediabetes stage might be a crucial time to consider these medications, rather than waiting until type 2 diabetes develops. The study's findings are preliminary and have not yet undergone full peer review. Limitations include the observational nature of the study, which cannot definitively prove causation, and the grouping of various GLP-1 medications, preventing differentiation between individual drugs.
Researchers noted potential confounding factors, such as medication dosage and patient adherence, that were not fully captured in electronic health records. They advised individuals with prediabetes and obesity to consult their doctors about all available treatment options and not to alter their medications independently.
While metformin remains a safe, affordable, and foundational treatment, particularly alongside lifestyle modifications like healthy eating, physical activity, and weight management, GLP-1 medications could be a valuable option for some patients. The decision to use these medications should be made collaboratively with a healthcare provider, considering the patient's overall health, other medical conditions, cost, and accessibility.