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GLP-1 receptor agonists beat metformin on nearly every front for adults with prediabetes and obesity, a large new study found. Patients on GLP-1s were more likely to reverse to normal blood sugar, less likely to develop type 2 diabetes, and had significantly lower risks of heart failure, stroke, and death. Researchers say the findings could reshape shared decision-making — though prospective studies are still needed.
GLP-1s are pulling ahead of metformin — and not just for weight loss
A large observational study presented at the American Heart Association Scientific Sessions found that adults with prediabetes and obesity taking a GLP-1 receptor agonist fared significantly better than those on metformin across glycemic and cardiovascular outcomes. Researchers used TriNetX data from over 250,000 patients across 104 institutions, matching 128,846 patients in each group and following them for about three years.
GLP-1 users were 53% more likely to revert to normal blood sugar and 31% less likely to progress to type 2 diabetes. The cardiovascular benefits were also notable — including a 41% lower risk of all-cause mortality and meaningful reductions in heart failure, stroke, heart attack, and cardiac arrest.
By the Numbers:
Why it matters: Metformin remains a safe, affordable first-line option, but these findings may prompt clinicians to consider GLP-1s earlier — before type 2 diabetes even develops. Researchers caution the results are preliminary and observational, but the scale and consistency of the data make a compelling case for revisiting treatment conversations with at-risk patients.
