A health-records analysis of more than a quarter of a million adults with prediabetes and obesity found that GLP-1 receptor agonist users were substantially less likely to progress to type 2 diabetes than metformin users. The results were released ahead of the American Heart Association's Scientific Sessions 2026 and are not peer-reviewed.
What Happened
Researchers reviewed records for 256,492 adults with both prediabetes and obesity from the TriNetX network, covering 104 institutions from 2010 to 2023, with an average follow-up of about three years.
About half took a GLP-1 — semaglutide, tirzepatide, liraglutide or dulaglutide — and half took metformin. Records were matched on age, comorbidities and concurrent medications, so outcome gaps more likely reflect the drug than the patient.
Compared with metformin users, GLP-1 users showed:
- 31 percent lower risk of developing type 2 diabetes
- 41 percent lower risk of death from any cause
- About 1.5 times higher likelihood of blood sugar returning to normal — 37.3 percent versus 29.3 percent
- 15 percent fewer heart attacks, 20 percent fewer strokes, 25 percent fewer heart failure cases and 8 percent fewer atrial fibrillation cases
"Prediabetes is still possible to reverse," said lead author Vinicius de Sousa Barzon Serra, a cardiovascular medicine research fellow at Mayo Clinic in Scottsdale, Arizona. He framed the finding as support for discussing GLP-1 therapy earlier in selected patients rather than waiting for a diabetes diagnosis.
Who Is Affected
Roughly 40 percent of U.S. adults have prediabetes, and up to 10 percent progress to type 2 diabetes each year. Anyone currently on metformin for prediabetes — a cheap, generic, decades-old first-line standard — is the population this speaks to directly, as is the compounded-GLP-1 market, which will read the result as validation whether or not the design supports the inference.
Timeline
- 2010–2023 — coverage period of the underlying records.
- 2 November 2026 — results released ahead of the meeting.
- 6–9 November 2026 — presentation at AHA Scientific Sessions in Chicago.
- Pending — full manuscript and peer review; until then the findings are preliminary.
What This Means for Researchers
The headline numbers are large and directionally consistent across glycaemic and cardiovascular endpoints. The design limits matter equally, and the authors list them: the study is observational, so it cannot prove cause and effect; patients and outcomes were identified through diagnosis codes, which can be incomplete; adherence and actual dose are invisible in prescription records; and all GLP-1 agents were pooled, so differences between molecules are not captured.
Robert Eckel, a past AHA president not involved in the work, framed it usefully: the benefit likely tracks weight loss, already known to reduce diabetes progression, and GLP-1s may function as an add-on rather than a replacement. He flagged cost and access as the practical constraints.
How to Verify Your Peptides
Population data does not travel to an individual vial. How testing works explains what independent analysis can and cannot establish, and identity, purity and fill weight covers what a usable certificate of analysis should contain.
Background on the molecules discussed is on our peptide reference pages, including semaglutide and tirzepatide.
Safe Alternatives
Metformin remains inexpensive, well characterised and first-line for prediabetes. Approved GLP-1 products carry manufacturing and pharmacovigilance oversight that compounded or research-grade vials do not. Our vendor directory scores suppliers on documentation and transparency, and our tools reflect approved schedules only.
Sources
- Industry reports — American Heart Association Scientific Sessions 2026 abstract release, 2 November 2026.
- Regulatory announcements — AHA statistical data on prediabetes prevalence, 2026.