Patients with type 2 diabetes who stop taking weight-loss injections like Ozempic may face double the risk of heart attack or stroke and a nearly fivefold increase in the risk of death, according to a major study published in The Lancet Regional Health. The findings raise concerns about the consequences of discontinuing glucagon-like peptide-1 (GLP-1) receptor agonists, particularly as the elevated risks persisted even in individuals who regained minimal weight after stopping treatment.
The study, which analyzed the medical records of over 80,000 people with type 2 diabetes in Italy over a decade, found that approximately 60 percent ceased taking these medications. Researchers observed that those who stopped treatment were roughly twice as likely to experience a heart attack or stroke compared to those who continued the drugs. Their risk of dying from any cause was nearly five times higher.
These results suggest that GLP-1 receptor agonists may offer protective benefits for the heart that extend beyond their weight-loss effects. Previous research indicated that patients typically regain about two-thirds of the weight lost after stopping these treatments, prompting concerns about long-term health. However, this latest study indicates that weight regain may only be part of the issue.
Researchers noted that patients who stopped treatment regained relatively little weight and showed only minor changes in blood sugar control, leading them to hypothesize that the drugs might have significant benefits independent of weight reduction. They cautioned, however, that stopping treatment could also be an indicator that some patients were already experiencing declining health.
GLP-1 receptor agonists have become widely used treatments for obesity and type 2 diabetes, with millions of people in the UK alone taking them. Many patients discontinue their use within the first year, often due to side effects like nausea and vomiting, or the cost of private prescriptions. The study suggests that long-term use might be necessary to maintain protection against heart disease and premature death.
While the study was observational and cannot definitively prove causation, experts offer strategies for managing the transition off these medications. Gradually reducing the dosage rather than stopping abruptly, as demonstrated in a 2024 study where patients tapered their medication over nine weeks and maintained weight loss, is one approach. Professor David Strain, an expert in metabolic disease, recommends reducing the dose and then extending the time between injections. Exercise is also highlighted as a key factor; a Danish study found that individuals who exercised regularly while on liraglutide regained significantly less weight after stopping the drug compared to those who relied solely on medication.
Additional recommendations for maintaining weight loss and cardiovascular health include consuming adequate protein and fiber, exercising regularly, and prioritizing quality sleep. Patients considering any changes to their medication regimen are strongly advised to consult their doctor to discuss potential cardiovascular risks and alternative treatment options, including SGLT2 inhibitors, which have demonstrated cardiovascular and kidney benefits, and to monitor blood sugar, cholesterol, and blood pressure levels.