For diabetes prevention, GLP-1 therapies outperform metformin

Clinical takeaway: Discuss potential glycemic and cardiovascular benefits of GLP-1–based therapy with patients who have prediabetes and obesity, alongside cost, access, and lifestyle changes. Treatment decisions should account for the preliminary, observational nature of these findings.

Prediabetes increases the risk of type 2 diabetes and cardiovascular disease, particularly in people with obesity. Direct comparisons of GLP-1–based therapies with metformin in this population remain limited.

Researchers analyzed health records for more than 250,000 adults, matching GLP-1–based therapy users with metformin users. Participants had prediabetes and obesity but no prior diabetes, ischemic heart disease, stroke, heart failure, or atrial fibrillation.

Normal blood glucose levels were recorded in 37.3% of GLP-1–based therapy users versus 29.3% of metformin users. Diabetes developed in 25.1% versus 37.0%, respectively.

Compared with metformin, GLP-1–based therapy was also associated with lower all-cause mortality and fewer acute heart failure, ischemic stroke, and myocardial infarction events.

The findings were presentated at the American Heart Association’s Scientific Sessions 2026 and have not yet been peer reviewed. Prospective randomized trials are needed to establish whether the medications caused these differences.

“This is less about replacing one medication with another and more about discussing additional options with specific patients,” said study author Vinicius de Sousa Barzon Serra, MD, of Mayo Clinic.

Source: Serra VDSB, et al. (2026 Nov 2) American Heart Association Scientific Sessions 2026, Abstract MDP1524. Glucagon-Like Peptide-1 Receptor Agonists versus Metformin for Glycemic Control and Cardiovascular Risk Reduction in Adults with Prediabetes and Obesity