How GLP-1 Receptor Agonists Are Transforming Diabetes Care
- t2diabetesnetwork
- Jun 23
- 8 min read
Blog Highlights
✅ GLP-1 RAs manage blood sugar and support weight loss for T2D and obesity.
✅ Approved GLP-1 RAs in Canada include semaglutide, liraglutide, and dulaglutide.
✅ GLP-1 RAs reduce cardiovascular risks but may cause nausea and GI issues.
✅ GLP-1 RA use is rising among non-diabetics, raising concerns about misuse.
If you’re living with type 2 diabetes (T2D) or struggling with obesity, you may have heard about a new class of medications called GLP-1 receptor agonists (GLP-1 RAs). These drugs are making headlines for their ability to lower blood sugar and support weight loss — but what are they and how do they work? Let’s break it down.
What are GLP-1 Receptor Agonists
GLP-1 agonists (short for glucagon-like peptide-1 receptor agonists) are medications that mimic a hormone naturally produced in the gut. This hormone helps regulate blood sugar and appetite, especially after eating. When used as medication, GLP-1 RAs increase insulin production when blood sugar is high, reduce the amount of glucagon (a hormone that raises blood sugar), slow digestion, and increase feelings of fullness; all of which contribute to better blood sugar control and weight management. Most GLP-1 RAs are injectable, but oral options are also available, such as semaglutide tablets.
These medications are primarily prescribed for people with T2D who need more than just metformin to control their blood sugar. They are also used for people living with obesity (defined as a body mass index, or BMI, of 30 or more) or overweight individuals (BMI of 27 or more) who have related health issues like high blood pressure or cholesterol. It’s important to note that GLP-1 agonists are not approved for use in Type 1 diabetes in Canada, although they may occasionally be prescribed off-label in unique circumstances.
Medication | Brand Name(s) | Use | Frequency | Approved in Canada? |
Dulaglutide | Trulicity® | T2D | Weekly injection | ✅ Yes |
Exenatide | Byetta®, Bydureon® | T2D | Twice daily or weekly | ✅ Yes |
Liraglutide | Victoza® (T2D), Saxenda® (weight loss) | T2D, Weight Management | Daily injection | ✅ Yes |
Lixisenatide | Adlyxine® | T2D | Daily injection | ✅ Yes |
Semaglutide | Ozempic® (T2D), Rybelsus® (oral for T2D), Wegovy® (weight loss) | T2D, Weight Management | Once weekly (injection) or daily (oral) | ✅ Yes (Wegovy approved in 2025) |
Tirzepatide | Mounjaro® | T2D (weight loss under review) | Weekly injection | ✅ Yes (Approved in 2024) |
Wegovy®, a higher dose of semaglutide used for weight loss, was recently approved by Health Canada. However, due to high global demand, access may be limited in some areas.
What are the benefits?
The benefits of GLP-1 RAs go beyond just lowering blood sugar. They can also improve other health markers such as blood pressure and cholesterol levels. Some studies suggest that they help reduce the risk of heart and kidney disease, support liver health (especially in people with fatty liver disease), and may delay the progression of diabetic kidney complications.
A pivotal 2021 clinical trial of semaglutide showed that participants lost an average of 15% of their body weight over 68 weeks, compared to just 2% in the placebo group. Some individuals even lost up to 20% of their initial weight. More recently, the potential health advantages of these drugs have expanded. Findings from the SELECT trial, published in 2023, revealed that semaglutide reduced the risk of heart attack and stroke by 20% in people with pre-existing cardiovascular disease.
Across other large studies, GLP-1RAs showed consistent and significant health benefits beyond glycemic control. A comprehensive cohort study using U.S. Veterans Affairs databases found that GLP-1RA use was associated with reduced risks of major adverse cardiovascular events (MACE), stroke, heart failure, cardiac arrest, and thromboembolic disorders. Neurocognitive benefits included a lower incidence of Alzheimer’s disease, dementia, and psychotic disorders such as schizophrenia. The same study also reported fewer cases of respiratory failure, pneumonia, substance use disorders, and seizures.
These findings were echoed in a large-scale adjusted analysis involving 7 million person-years of data. Additionally, a meta-analysis of 26 trials concluded that GLP-1RAs were particularly effective in reducing macrovascular and microvascular complications, positioning them as a strong therapeutic choice for patients at risk of cardiovascular and cerebrovascular disease.
What are the risks?
As of 28 October 2024, the UK Government's med watch database (MHRA) received over 7,000 reports of gastrointestinal side effects linked to GLP-1RAs, with some resulting in hospitalization.
Despite their benefits, GLP-1RAs carry several notable risks. Common ones reported by the Government of Canada include nausea, vomiting, diarrhea, and loss of appetite, especially when starting the medication or increasing the dose. Some people also experience headaches, dizziness, or mild injection site reactions. More serious but rare side effects include pancreatitis, kidney issues, allergic reactions, and possible thyroid tumors (seen in animal studies). These medications are not recommended during pregnancy, and they may increase the risk of hypoglycemia (low blood sugar) when used with insulin or sulfonylureas.
Studies have noted higher rates of gastrointestinal disorders, hypotension, syncope, kidney stones (nephrolithiasis), interstitial nephritis, and drug-induced pancreatitis. These findings were confirmed by the observational analysis, which also reported increased musculoskeletal issues such as arthralgias and arthritis. Additionally, other studies have found an elevated risk of thyroid cancer in GLP-1RA users (odds ratio 1.58), further emphasizing the need for careful patient selection. Compared to alternate T2D drugs, GLP-1RAs have a unique adverse effect profile that necessitates individualized prescribing based on tolerability and risk factors.
What happens if GLP-1 RAs are stopped?
While GLP-1 RA drugs are effective, their high cost ( US$1,350/month) and side effects (nausea, stomach pain, heartburn) raise concerns, especially about what happens after stopping treatment.
Numerous studies have investigated this question, and the results are consistent: weight often returns once treatment is stopped. In one trial, participants lost nearly 11% of their body weight with weekly semaglutide injections, dietary changes, exercise, and psychological counseling. However, when a third of the participants were switched to a placebo for the following year, they regained 7% of the weight they had lost.
A similar trend was observed in the STEP 1 trial of 2021. After 68 weeks on semaglutide, patients had lost an average of over 15% of their body weight. But within 12 months of stopping treatment, they regained two-thirds of the weight they had lost, along with a significant reversal of improvements in some cardiometabolic markers, such as those related to diabetes and heart disease.
The pivotal 2021 clinical trial of semaglutide revealed that nearly 14% of participants were unable to lose even 5% of their body weight, despite being on the medication for over a year. And only around 10% of people were able to maintain all the weight they’ve lost.
In another study, patients without T2D were more likely to stop using GLP-1 drugs: about 65% discontinued within a year, compared to 46% of those with type 2 diabetes. After two years, the discontinuation rates rise to 84% for non-diabetic patients and 64% for diabetics. The study highlights that those experiencing fewer side effects are less likely to quit, emphasizing the impact of tolerability and affordability on long-term use.
For most, the weight returns quickly, typically within the first 3 to 6 months. This pattern mirrors what’s seen in other chronic conditions, where relapses occur once treatment stops.
Understanding why weight regain happens after discontinuing GLP-1 treatment could be crucial for determining their long-term health impacts and the best way to prescribe them in the future.
How are GLP-1 RAs Changing T2D Treatment Options
Many patients have reported positive experiences with GLP-1 receptor agonists. For instance, those who were previously unable to control their blood sugar levels or face considerable weight challenges have found success with these medications. Patients often highlight the ease of use, GLP-1 receptor agonists can be administered via daily or weekly injections, depending on the specific medication. Additionally, many patients appreciate the positive side effects, such as weight loss, rather than severe drawbacks associated with some diabetes medications.
However, these drugs appear to be having a wider impact than the physical state and are reshaping culture and society.
An article by Matthew Schneier for New York Magazine explores how the diabetes drug Ozempic, and similar medications, are transforming not just bodies, but the very culture and psychology of eating, thinness, and status.
Laila Gohar (artist): “Everyone in L.A. is skinny now... Well, the last few people who weren’t, now are.” Gohar notes the dramatic, visible impact of Ozempic on entire social scenes.
The piece investigates how drugs like Ozempic, originally for diabetes, have become status symbols and appetite suppressants among the non-diabetic elite, especially in entertainment and fashion. Quotes from users, doctors, and cultural commentators reveal a landscape where weight loss is now quick, medicalized, and quietly omnipresent; reshaping not just bodies, but the meaning of food, self-control, and social status
Dr. Holly Lofton (NYU Langone Health) details the overwhelming demand for these drugs, even among those not strictly medically eligible.
“The last six months, I’ve written 1,400 prescriptions for semaglutide... They come in begging for it. If I give them pills, they’re disappointed.” -- Lofton
These social and cultural changes have increased demand, motivating illegal methods to obtain the drugs. The UK Government MHRA warns against the misuse of falsified GLP-1RAs, often acquired without a prescription, and the growing trend of using these medications for aesthetic weight loss. Healthcare providers should stress that these drugs should only be obtained from authorized sources and used under medical supervision.
Nevertheless, GLP-1 drugs are skyrocketing in popularity even in those without T2D. A 2024 study published in The BMJ reports a staggering 700% increase in the number of U.S. adults without diabetes who began GLP-1RA treatment between 2019 and 2023.
According to researchers from the University of Pennsylvania and Cedars-Sinai Medical Center, the number of non-diabetic patients starting these medications jumped from 21,000 in 2019 to over 174,000 in 2023. Using data from over 45 million de-identified patient records, the team found that more than 870,000 people were prescribed a GLP-1RA between 2011 and 2023. Notably, nearly two-thirds of these users did not have diabetes, and the majority (59.6%) were women.
The growing demand for pharmacological tools to support weight loss, beyond traditional lifestyle interventions, reflect a broader shift in how these powerful medications are being used in clinical practice.
The Future of Diabetes Care with GLP-1 RAs
The landscape of diabetes care continues to evolve, and GLP-1 RAs are at the forefront of this transformation. With ongoing research, new formulations, and combination therapies on the horizon, patients can expect even more innovative options for managing their diabetes.
Advancements in technology, such as connected pen caps that track medication use and integrate data with smartphone applications, will enhance patient engagement and adherence. Increased awareness about the benefits and accessibility of GLP-1 RAs will also play a significant role in diabetes management moving forward.
As we look ahead, it is evident that GLP-1 RAs are revolutionizing diabetes care. Their ability to improve blood sugar control, facilitate weight loss, and significantly impact cardiovascular health sets these medications apart as vital tools in diabetes management.
As demand and options are shaped by GLP-1 RAs, a growing need for support is becoming evident. Support groups and communities, like the glp-1 forum, provide patients with a platform to share their experiences and learn from others. This shared knowledge can empower patients in their diabetes management journey.
Understanding and utilizing GLP-1 RAs alongside a balanced lifestyle can empower individuals to take control of their diabetes. The integration of technology, community support, and evidence-based medication will shape the future of diabetes care, ensuring better outcomes for patients worldwide.
How do you feel about the potential of GLP-1 receptor agonists in transforming diabetes management?
Excited about new treatment options
Cautiously optimistic, need more research
Prefer traditional treatment methods
Not sure about GLP-1 RA and its effectiveness
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