A cohort study published in Diabetes Research and Clinical Practice reports that initiation of GLP-1 receptor agonists and SGLT2 inhibitors among U.S. adults with type 2 diabetes and obesity rose sharply between 2010 and 2024, while bariatric surgery did not. Adherence and persistence, the authors write, remain low across both drug classes.

GLP-1 receptor agonists include semaglutide (sold as Ozempic and Wegovy) and tirzepatide (Mounjaro and Zepbound), peptide-based drugs that act on gut hormone receptors involved in blood sugar and appetite. SGLT2 inhibitors are small-molecule drugs that work through the kidney instead, and metabolic bariatric surgery is the surgical route to the same set of outcomes.

What the data covers

The researchers used electronic health record and claims data from the Optum Labs Data Warehouse, covering privately insured and Medicare Advantage enrollees aged 18 to 79. That yielded 342,932 treatment initiations across 335,605 individuals over the fifteen-year window.

Key results

Of those initiations, 60.8% were GLP-1 receptor agonists, 35.7% were SGLT2 inhibitors, and 3.6% were surgery. Annual GLP-1 starts climbed from 1,988 to 44,852 across the study period, and SGLT2 inhibitor starts from 861 to 19,892.

By 2024 the GLP-1 category had consolidated around two drugs: semaglutide accounted for 62.2% of initiations in that class and tirzepatide for 32.6%. Surgery, meanwhile, made up 0.7% of all treatments that year, which is the most striking number in the paper and the one that gets the least attention in coverage of this field.

The staying-on problem

Median treatment duration was 240 days for GLP-1 receptor agonists and 254 days for SGLT2 inhibitors, and roughly half of initiators met the study's adherence threshold of medication on hand for at least 80% of days. At one year, 53.0% of GLP-1 initiators and 56.0% of SGLT2 initiators were still on their starting treatment, and switching to another therapy was uncommon.

Tirzepatide showed the highest adherence and persistence of the drugs examined. The authors do not attribute a cause for that difference.

Limitations

This is observational claims and record data from insured populations, not a trial, so it describes prescribing patterns rather than outcomes. The uninsured are absent by design. The authors say further studies are needed to evaluate how these shifting patterns affect health outcomes.

Where the prescribing curve goes next

The growth story here is real, and so is the drop-off behind it. What nobody has yet measured at this scale is what half a year of therapy actually buys a patient who stops.