GLP-1 dropout is common, but so is restarting

Clinical takeaway: Treat early discontinuation as a time to check-in. Target follow-up support to patients most likely to lapse, including those on Medicaid or Medicare and those reporting gastrointestinal side effects.

Consistent GLP-1 use is what delivers cardiovascular, renal and weight loss benefits, yet little has been known about how reliably patients stay on therapy. New data offer insight into discontinuation and return trends among type 2 diabetes patients.

About 4 in 10 patients stopped their GLP-1 within the first year; nearly 6 in 10 had stopped by two years. This was defined as a discontinuation gap of more than 60 days in fills. But stopping was often not the end: 41.5% of those who discontinued restarted within a year, and 58% had restarted within two.

Patients on Medicaid or Medicare, Black patients, and the more than one-third who reported nausea or other GI side effects were more likely to discontinue within a year. Drug choice mattered too: tirzepatide users were 41% less likely to discontinue than those on older liraglutide, and semaglutide users 28% less likely. Having an endocrinologist write the first prescription lowered the odds of stopping by 10%.

The retrospective cohort study drew on Komodo Health U.S. claims from January 2019 to June 2025, covering more than 60,000 adults aged 18 to 64 with type 2 diabetes and a BMI of 25 or higher who started liraglutide, semaglutide, or tirzepatide. The findings, presented at the Endocrine Society's annual meeting (ENDO 2026), have not yet undergone full peer review.

The pattern suggests clinicians and insurers may be underestimating how many patients cycle off and back onto therapy, and that retention efforts could focus less on preventing every gap and more on shortening time off the drug. Whether intermittent use erodes the cardiovascular and renal benefits that depend on sustained exposure remains an open question.

"This research matters because consistent use of these medications is what produces their protective effects. Stopping early may mean missed opportunities to prevent heart attacks, kidney disease progression and other complications," said Sainikhil Sontha, MS, a research associate at the Boston University School of Public Health.

Source: Sontha S. ENDO 2026. 2026 Jun 14. More than half of those who stop GLP-1s restart within a year