Persistence in GLP-1-Based Therapy Among Adults with Obesity and Type 2 Diabetes: A Narrative Review of Definitions, Real-World Outcomes, and Determinants.
Level 5 - mechanism / opinion, no new human data
Narrative review synthesizing published observational studies without formal systematic methodology or meta-analysis.
PubMed 42603234 · doi:10.1007/s11892-026-01639-0
What was done
This narrative review evaluated real-world persistence with GLP-1-based therapies among adults with comorbid obesity and type 2 diabetes. Seven studies with follow-up periods ranging from 6 months to 2 years met inclusion criteria. The authors reviewed definitions of persistence, continuation and discontinuation trajectories, determinants of persistence, reasons for stopping therapy, and supportive management strategies.
What was found
Persistence rates generally declined over time, frequently falling below 60% by 12 to 24 months. In one large cohort, discontinuation reached 64.1% at 2 years, though treatment interruption followed by reinitiation was common. Persistence varied by age, income, gastrointestinal adverse events, achieved weight reduction, baseline BMI metrics, specific GLP-1 agent, formulation, and dosing schedule. Only two studies reported patient-level reasons for stopping (most frequently adverse effects), and none described structured behavioral or supportive strategies.
Why it matters
While GLP-1 therapies show high efficacy in clinical trials, real-world continuation drops substantially within one to two years, limiting sustained metabolic and weight benefits.
Limits
The review included only seven studies and was conducted as a narrative rather than a systematic review. Included studies used heterogeneous refill-gap definitions and analytic approaches, precluding meta-analysis. Only two studies documented patient-reported reasons for discontinuation, and data evaluating supportive interventions were entirely absent.
Cited by
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