GLP-1s did not improve odds of stopping insulin in T2D

Clinical takeaway: When adding a GLP-1 receptor agonist for patients with type 2 diabetes receiving basal insulin, continue to individualize treatment goals rather than expecting insulin discontinuation. Decisions to reduce or stop insulin should remain guided by glycemic control, hypoglycemia risk, and patient-specific factors.

GLP-1 receptor agonists can reduce insulin requirements, promote weight loss, and improve glycemic control, leading many clinicians and patients to hope they may also allow insulin to be discontinued. However, this large real-world study suggests that expectation may not be realistic for most patients already receiving basal insulin.

Investigators used US Veterans Health Administration data to emulate a target trial comparing nearly 8,900 matched patients with type 2 diabetes who initiated a GLP-1 receptor agonist, an SGLT2 inhibitor, or a DPP-4 inhibitor while receiving basal insulin. Nearly half had an HbA1c of 9% or higher at baseline, reflecting a population with substantial hyperglycemia.

Over three years, insulin discontinuation occurred in 16.7% of patients who started a GLP-1 receptor agonist, compared with 17.9% of those starting an SGLT2 inhibitor and 17.1% of those starting a DPP-4 inhibitor. GLP-1 receptor agonists did not significantly increase the likelihood of stopping insulin compared with either oral drug class, and the findings were consistent across patient subgroups and sensitivity analyses.

The results reinforce that while GLP-1 receptor agonists remain valuable for improving glycemic control, reducing weight, and providing cardiovascular and kidney benefits in appropriate patients, insulin discontinuation should not be considered an expected outcome of adding these agents. Many patients with longstanding or poorly controlled type 2 diabetes are likely to require ongoing basal insulin despite treatment intensification.

“Our findings do not support preferential use of GLP-1RAs over SGLT-2is or DPP-4is solely to increase the likelihood of insulin discontinuation in patients with type 2 diabetes receiving basal insulin,” the study authors concluded.

Source: Lipska KJ, et al. (2026 Jul 14) Ann Intern Med. Comparative Effectiveness of Glucagon-like Peptide-1 Receptor Agonists Versus Oral Agents for Insulin Discontinuation in Type 2 Diabetes: A Target Trial Emulation