GLP-1 meds linked to lower diabetes, heart risks than standard diabetes prevention medication
· Medical Xpressedited by Sadie Harley, reviewed by Andrew Zinin
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GLP-1 (glucagon-like peptide-1 receptor agonists) medications, currently popular for weight loss, may help prevent type 2 diabetes and lower the risk of heart attack and stroke more than the standard diabetes prevention medication metformin among people with prediabetes, according to new, independent, preliminary research presented at the American Heart Association's Scientific Sessions 2026, held Nov. 6–9 in Chicago.
The study, which reviewed health records for more than 250,000 adults with prediabetes and obesity, is among the largest studies to evaluate the impact of GLP-1 medications compared with metformin—the current gold-standard, first-line medication for treating prediabetes and type 2 diabetes, along with lifestyle modification.
Most prior research on GLP-1 medications focused on people who already had type 2 diabetes, according to study author Vinicius de Sousa Barzon Serra, M.D. This study investigated the earlier prediabetes stage and captured the impact of GLP-1s on blood sugar and heart and stroke risk.
In prediabetes, blood sugar levels are above normal yet not high enough for a diabetes diagnosis. Nearly 40% of U.S. adults have prediabetes, according to the American Heart Association's 2026 Heart Disease and Stroke Statistics. Prediabetes progresses to type 2 diabetes for up to 10% of these adults each year, according to statistics from the National Institutes of Health.
"The great news with prediabetes is that it's still possible to reverse the progression of the disease," said Serra, a research fellow in the department of cardiovascular medicine at the Mayo Clinic in Scottsdale, Arizona. "This research may add to the case for considering GLP-1 medications earlier for certain patients, rather than waiting until they develop type 2 diabetes."
In general, about 1 out of 10 U.S. adults may be taking GLP-1 medications for blood sugar control or weight loss, according to 2026 health care survey information garnered from more than 2,800 hospitals and health systems nationwide.
In this analysis of more than 250,000 adults with prediabetes and obesity, about half were taking the GLP-1-based medications semaglutide, tirzepatide, liraglutide or dulaglutide, while the other half were taking metformin.
What were the study's main findings?
- Compared with those taking metformin, participants in the study taking GLP-1s had: a 1.5 times higher chance of reversing high blood sugar to normal levels; a 31% lower risk of developing type 2 diabetes; and a 41% lower risk of death from any cause.
- GLP-1 medications were also associated with 15% fewer heart attacks, 20% fewer strokes, 25% fewer cases of heart failure and 8% fewer cases of atrial fibrillation (AFib), a common type of irregular heartbeat.
"The main effect these findings could have is on the shared decision-making discussion between doctors and patients exploring various treatment options, and the pros and cons for each," said Serra. "Metformin is still a first-line treatment choice. It is safe, inexpensive and has a long track record. This is less about replacing one medication with another and more about discussing additional options with specific patients," he said.
"It's important to note that an essential component of prediabetes treatment is lifestyle changes to manage weight, including diet and exercise and considering medications, including metformin, based on each individual's overall health and any other medical conditions," said Serra.
American Heart Association past volunteer president Robert Eckel, M.D., FAHA, said the findings are not surprising. "The benefits noted in this study likely relate to the patients losing weight, which is known to help prevent type 2 diabetes," said Eckel, professor of medicine emeritus at the University of Colorado Anschutz Medical Campus.
"Preventing the progression from prediabetes to type 2 diabetes keeps patients from having type 2 diabetes, and it also helps prevent heart attacks and strokes."
"GLP-1s provide another option for prevention, perhaps as an add-on therapy," said Eckel, who was not involved in this study. "However, costs and access to these medications are important factors."
Study details, background, design and limitations:
- Researchers reviewed the electronic health records for 256,492 adults (average age 52, 76% women) diagnosed with prediabetes and obesity.
- The health data were extracted from the TriNetX global multicenter electronic health record network, based on 104 institutions from 2010 to 2023, and patients were followed for an average of roughly three years.
- The researchers compared data among people who took metformin with those who took a GLP-1 medication, analyzing how the medication affected blood sugar and the risk of type 2 diabetes, heart disease, stroke or death.
- The researchers paired records of patients with similar ages, health conditions (such as high blood pressure, sleep apnea or nicotine dependence) and medications. This matching helped ensure any differences in health outcomes were likely from the medication itself, rather than other differences.
- The study is observational and, therefore, cannot prove a cause-and-effect relationship. Other limitations include that patients and outcomes were identified through diagnosis codes, which can be incomplete; researchers relied on prescription records, so how consistently patients took medication or at what dose is not reflected; and GLP-1-based medications were grouped together, so individual differences between agents were not considered.
Key medical concepts
Glucagon-Like Peptide-1 Receptor AgonistsMetforminDiabetes Type 2PrediabetesMyocardial infarction
Clinical categories
EndocrinologyCommon illnesses & PreventionCardiologyWeight management Provided by American Heart Association Who's behind this story?
Sadie Harley
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Andrew Zinin
Master's in physics with research experience. Long-time science news enthusiast. Plays key role in Science X's editorial success. Full profile →
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