BMJ Med
Stopping GLP-1 therapy may reverse cardiovascular benefits in patients with type 2 diabetes
Clinical takeaway: Reinforce the importance of uninterrupted GLP‑1 receptor agonist (GLP-1 RA) therapy—minimizing gaps in treatment may be critical to preserving cardiovascular benefit in patients with type 2 diabetes.
A target trial emulation using U.S. Veterans Affairs data (132,551 GLP-1 RA users; 201,136 sulfonylurea users) found that both discontinuing and interrupting GLP‑1 RA therapy substantially weakened its cardiovascular benefit. Patients who used GLP-1 RAs continuously for three years had an 18% reduction in major adverse cardiovascular events (MACE) compared with sulfonylureas (incidence risk ratio [IRR], 0.82; 95% confidence interval [CI], 0.78–0.85). In contrast, stopping GLP‑1 RAs after only 0.5–1.5 years resulted in IRRs near 1.0, conveying no significant MACE reduction.
Compared with continuous use, even six months of discontinuation increased MACE risk (IRR 1.04), with longer gaps showing progressively higher risk—up to 22% increased risk after two years off therapy. Higher proportion of days covered correlated with lower cardiovascular event rates.
Source:
Xie Y, Choi T, and Al-Aly Z. (2026, March 18). BMJ Medicine. Glucagon-like peptide 1 receptor agonist discontinuation and risks of major adverse cardiovascular events in adults with type 2 diabetes: target trial emulation. https://doi.org/10.1136/bmjmed-2025-002150