Adults with prediabetes and obesity who took GLP-1-based medications had a 31% lower risk of developing type 2 diabetes and a 41% lower risk of death compared with those taking metformin.
Metformin is an oral medication used primarily to treat type 2 diabetes, widely considered the first-line treatment, combined with lifestyle modifications. It is also sometimes prescribed to people with prediabetes to help prevent or delay progression.
The findings, which come from a large observational study, are set to be presented at the American Heart Association’s Scientific Sessions 2026 this weekend in Chicago. They have not yet undergone the full peer review process.
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The study involved health records for 256,492 adults with prediabetes and obesity, averaging 52 years of age.
Approximately half of the group received GLP-1 (glucagon-like peptide-1 receptor agonists) medications – including semaglutide, tirzepatide, liraglutide and dulaglutide – and half received metformin.
Based on a three-year follow-up, in addition to the lower risk of diabetes and all-cause mortality, GLP-1–based medications were associated with 20% fewer strokes, 15% fewer heart attacks and 25% fewer cases of heart failure.
“The 41% lower risk of death from any cause surprised me most,” study author Vinicius de Sousa Barzon Serra, M.D., a research fellow in the department of cardiovascular medicine at the Mayo Clinic in Scottsdale, Arizona, told Fox News Digital.
“I expected GLP-1 medications to do better than metformin on blood sugar and diabetes risk, because they lead to much more weight loss. I was also struck that the benefit appeared across many outcomes, including heart attack, stroke, heart failure and atrial fibrillation.”
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Nearly 40% of U.S. adults have prediabetes, according to statistics from the AHA. That condition is marked by blood sugar levels that are above normal but not yet elevated enough for a diabetes diagnosis.
As many as 10% of those with prediabetes will go on to develop type 2 diabetes each year.
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“Most earlier research on these medications focused on people who already had diabetes,” Serra noted. “Our study suggests the prediabetes stage may be an important time to consider them, rather than waiting until they develop type 2 diabetes.”
The study did have some limitations. While it found a link between GLP-1 medications and better health outcomes, it does not prove that the drugs were responsible.
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The findings are preliminary until published in a peer-reviewed journal, Serra noted.
“We matched patients by age, health conditions and other characteristics to make the groups comparable … even so, other differences between the groups may remain,” he said. “We also grouped the GLP-1 medications together, so we could not tell whether individual drugs differ.”
The study relied on patients’ electronic health records, which may have contained missing or incorrect information. It is also possible that factors not measured in the study, such as medication dosage and compliance, could have influenced the results, the researchers noted.
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People with prediabetes and obesity should talk with their doctor about all their options and should not stop or change any medication on their own, Serra advised.
“Metformin is a safe, inexpensive option with a long track record, and lifestyle changes such as healthy eating, regular physical activity and weight management remain the foundation of treatment,” he emphasized to Fox News Digital.
“For some patients, a GLP-1 medication may be worth discussing, depending on their overall health, other medical conditions, cost and access. The decision should be made together with their doctor.”