Real-world effectiveness of glp-1 receptor agonists in older adults: concordant shifts in obesity and glycaemic categories
R Arbel, R Zaritsky, N Elior, T Razi, A Lustman, S Eilat-Tsanani, H Shahaf, N Sitry, M ShaniAbstract
Background
GLP-1 receptor agonists (GLP-1 RAs) produce substantial weight loss and glycaemic improvements in adults with obesity, yet real-world data on their effectiveness in older adults (≥65 years) without diabetes remain limited, particularly regarding transitions across clinically meaningful BMI and HbA1c categories.
Purpose
To evaluate shifts in BMI and HbA1c categories, and their concordance, among older adults initiating GLP-1 RAs without pre-existing diabetes.
Methods
This retrospective cohort study included members of a large healthcare organisation aged ≥65 years who initiated GLP-1 RA therapy (≥3 dispensations, 2018–2024) without a diagnosis of diabetes. BMI and HbA1c were measured before (up to 1 year prior) and after (≥6 months post-initiation) treatment. BMI was categorised as <30, 30–34.9, 35–39.9, and ≥40 kg/m²; HbA1c as <5.7%, 5.7–6.4%, and ≥6.5%. Category shifts were classified as improved, unchanged, or worsened, and cross-tabulated.
Results
Among 4,786 patients (median BMI 35 kg/m²; median HbA1c 5.8%), BMI category improved in 2,026 (42%) and worsened in 331 (7%). The proportion with BMI <30 kg/m² increased from 7% to 25%. HbA1c category improved in 1,852 (39%) and worsened in 211 (4%). Normoglycaemia (HbA1c <5.7%) rose from 34% to 67%; HbA1c ≥6.5% decreased from 8% to 5%. Concordant improvement in both domains occurred in 956 (20%); 61% improved in at least one domain. Among BMI improvers, 47% also improved in the HbA1c category. Concordant worsening was rare (<1%).
Conclusions
In this real-world cohort of older adults without diabetes, GLP-1 RA therapy was associated with favourable shifts in both obesity and glycaemic categories, with substantial concordance between improvements. These data support the cardiometabolic effectiveness of GLP-1 RAs in patients aged ≥65 and suggest that obesity treatment in this population confers dual benefit across weight and glycaemic trajectories.Infographic