New preliminary research presented at the American Heart Association’s Scientific Sessions 2026 suggests that glucagon-like peptide-1 receptor agonists (GLP-1 medications), widely known for weight loss, may be more effective than metformin at preventing Type 2 diabetes and reducing cardiovascular risks in adults with prediabetes and obesity. The study, which analyzed health records for more than 250,000 adults, is among the largest to compare GLP-1s with metformin, the current first-line medication for prediabetes and Type 2 diabetes. The findings could influence how clinicians and patients approach early intervention, particularly for a condition affecting nearly 40% of U.S. adults, according to the American Heart Association’s 2026 Heart Disease and Stroke Statistics.
In the analysis, about half of the participants took GLP-1 medications such as semaglutide, tirzepatide, liraglutide or dulaglutide, while the other half took metformin. Compared with metformin, those on GLP-1s had a 1.5 times higher chance of reversing high blood sugar to normal levels, a 31% lower risk of developing Type 2 diabetes, and a 41% lower risk of death from any cause over a five-year period. GLP-1 use was also associated with 15% fewer heart attacks, 20% fewer strokes, 25% fewer cases of heart failure and 8% fewer cases of atrial fibrillation. The research was presented at the Association’s premier global exchange of cardiovascular science, Scientific Sessions 2026, and the full abstract is available online.
“The great news with prediabetes is that it’s still possible to reverse the progression of the disease,” said study author Vinicius de Sousa Barzon Serra, M.D., a research fellow in cardiovascular medicine at the Mayo Clinic in Scottsdale, Arizona. “This research may add to the case for considering GLP-1 medications earlier for certain patients, rather than waiting until they develop Type 2 diabetes.” Serra emphasized that metformin remains a safe, inexpensive first-line option with a long track record. “This is less about replacing one medication with another and more about discussing additional options with specific patients,” he said. The implications extend to shared decision-making, as clinicians weigh the benefits of GLP-1s against their costs and access challenges.
American Heart Association past volunteer President Robert Eckel, M.D., FAHA, who was not involved in the study, noted that the benefits likely stem from weight loss, which is known to help prevent Type 2 diabetes and its cardiovascular complications. “GLP-1s provide another option for prevention, perhaps as an add-on therapy,” Eckel said, while cautioning that costs and access are important factors. The study is observational and cannot prove cause and effect, and it relied on diagnosis codes and prescription records, which may be incomplete. Still, the findings add to a growing body of evidence on the role of GLP-1s in cardiometabolic health, including prior research on healthy lifestyle combined with newer diabetes medications and weight loss medication’s effect on blood pressure.
With nearly 40% of U.S. adults having prediabetes and up to 10% progressing to Type 2 diabetes each year, the study underscores the potential for earlier and more tailored interventions. As obesity remains a major driver, the results may prompt broader discussions about incorporating GLP-1s into prediabetes management, especially for patients at high cardiovascular risk. The research was published as a meeting abstract and is considered preliminary until published in a peer-reviewed journal. For more information on the Association’s financial disclosures, visit here.
