Improving GLP-1 Adherence in Patients With Diabetes, With Vivian Fonseca, MD

Despite a steady flow of more and more efficacious GLP-1 RA treatments for obesity and diabetes, adherence rates remain low across multiple studies.¹

Prior research has cited a variety of reasons for discontinuation, including high cost and the treatment burden of many injection-based GLP-1 RAs. Additionally, the drugs are famously associated with various gastrointestinal effects including nausea, vomiting, and diarrhea.²

Presented at the American Diabetes Association (ADA) Scientific Sessions 2026 in New Orleans, Louisiana, by Leigh Perreault, MD, adjoint professor of medicine at the University of Colorado Anschutz, the present analysis worked to distill clear reasons for significantly lower adherence and persistence.

Vivian Fonseca, MD, professor of medicine, assistant dean for clinical research, the Tullis-Tulane Alumni Chair in Diabetes, and the chief of the Section of Endocrinology at Tulane University Medical Center in New Orleans, was affiliated with the study, and spoke with the HCPLive editorial team to discuss the study and its broader implications for the groundbreaking weight loss treatment.

“A well-known example of this is statins – when they first came out, they were revolutionary in preventing cardiovascular disease,” Fonseca told HCPLive in an exclusive interview. “While adherence used to not be particularly good, it’s improved tremendously in the last few years as it’s become more accepted by the medical community and the general public. However, there’s still a certain amount of non-adherence to care.”

The analysis collected a series of observational studies from 2014-2025 reporting persistence and/or adherence to GLP-1s in patients with type 2 diabetes (T2D). Persistence was defined as treatment gap thresholds from 30-90 days, while adherence was established as a proportion of days covered ≥80%. Among the investigated GLP-1s were tirzepatide, semaglutide, dulaglutide, and liraglutide. Additionally, the team utilized meta-analyses using restricted maximum likelihood random effects modeling to estimate overall pooled proportions and 95% confidence intervals.¹

A total of 28 studies were ultimately included in the trial, totaling 267,542 patients. Of these, 69% were persistent at 6 months (95% CI, 65-73%), and 49% were persistent at 12 months (95% CI, 43-55%). By 12 months, dulaglutide demonstrated the highest persistence rates (56%; 95% CI, 55-56%), followed by semaglutide (53%; 95% CI, 44-62%) and liraglutide (43%; 95% CI, 30-55%). Additionally, 50% of patients were adherent at 6 months (95% CI, 45-55%) and 42% were adherent at 12 months (95% CI, 37-47%). Dulaglutide also showed the highest adherence of included GLP-1 therapies (50%; 95% CI, 43-56%), followed by semaglutide (43%; 95% CI, 41-44%) and liraglutide (34%; 95% CI, 29-39%).¹

Ultimately, Perreault and colleagues concluded that GLP-1 persistence and adherence outside of clinical trials remained consistently low across the included studies. They note a substantial unmet need for strategies to promote sustained GLP-1 use to capitalize on the drugs’ efficacy in improving patient outcomes. Fonseca also provided advice for clinicians, highlighting the best way to address concerns about lifelong treatment use and potential workarounds for gastrointestinal adverse events.¹

“I think you need to talk to the patient about the advantages of long-term endurance. Tell them that this is for life,” Fonseca said. “You have obesity, which is a lifelong disease. It’s not going away because you lost the weight for a few months; you will regain the weight if you stop the therapy. But you also need to discuss tolerability issues, warn them about side effects, and say that there are ways to adhere to it.”

Editors’ Note: Fonseca reports disclosures with Novo Nordisk, Regeneron, Abbott, Corcept, Eli Lilly, and others.

References

1. Perreault L, Rasouli N, Sanogo F, et al. A Meta-Analysis of Persistence and Adherence to Glucagon-Like Peptide 1-Based Treatments among Patients with Type 2 Diabetes in the United States. Abstract presented at the American Diabetes Association (ADA) Scientific Sessions 2026, New Orleans, LA. June 5-8, 2026.

2. Heisey HD, Gregg LP, Verrico CD, Villareal DT, Fletcher TL. Rates of, Reasons for, and Reactions to Discontinuation of GLP-1 Receptor Agonists: A Narrative Review. Diabetes Obes Metab. Published online June 5, 2026. doi:10.1111/dom.70913