Mayo Clinic: GLP-1 drugs linked to 31% lower diabetes risk than metformin in observational study

A team led by Vinicius de Sousa Barzon Serra at Mayo Clinic in Scottsdale, Arizona, reported that GLP-1 receptor agonists were associated with a 31% lower risk of type 2 diabetes than metformin in adults with both prediabetes and obesity, according to ad-hoc-news.de ad-hoc-news.dead-hoc-news.dead-hoc-news.deOpen source ↗. The results were presented at the American Heart Association Scientific Sessions 2026, held 6–9 November 2026 in Chicago. The drugs analyzed were semaglutide, tirzepatide, liraglutide and dulaglutide.

Cohort and design

The analysis used the TriNetX database and covered 256,492 adults with documented prediabetes and obesity from 104 institutions, for the period 2010 to 2023. The mean age was 52 years, 76% of participants were women, and mean follow-up was about three years. About half of the patients in the GLP-1 group took one of the four named drugs, and the researchers analyzed them together as a drug class.

The authors state that this is a retrospective, non-randomized observational study, abstract MDP1524, which has not undergone formal peer review. They note that causal relationships cannot be directly derived from these preliminary data.

Glycemia, mortality and cardiovascular events

In the GLP-1 group, the chance of returning to normal blood glucose values was about 50% higher, or about 1.5 times, than in the metformin comparison group ad-hoc-news.dead-hoc-news.dead-hoc-news.deOpen source ↗. All-cause mortality was 41% lower.

Cardiovascular events were also less frequent in the GLP-1 group: heart failure by 25%, stroke by 20%, myocardial infarction by 15%, and atrial fibrillation by 8%.

Context

The American Heart Association points out that nearly 40% of adults in the US have prediabetes, and up to 10% of them develop manifest type 2 diabetes each year. Mayo Clinic states that metformin remains first-line therapy for prediabetes, describing it as safe, inexpensive and proven over decades. It also states that lifestyle changes remain the basis of any prevention.