Who stops a GLP-1 — and who comes back: what a 60,000-patient study found

• About 4 in 10 people with type 2 diabetes stopped their GLP-1 medication within the first year; about 6 in 10 had stopped by the end of two years.
• More than half of those who stopped restarted within one year (41.5%), and nearly two-thirds did so within two years (58%).
• Patients on tirzepatide were 41% less likely to discontinue than those on liraglutide; semaglutide users were 28% less likely to stop than those on older medications.
• This study covered people with type 2 diabetes specifically — findings should not be generalized to people using GLP-1s for obesity without diabetes.

The study was conducted by Sainikhil Sontha, M.S., and colleagues at Boston University School of Public Health, and presented at ENDO 2026 in Chicago on June 14, 2026.

The researchers performed a retrospective cohort study using Komodo Health U.S. claims data covering January 2019 through June 2025. The group included adults aged 18 to 64 with a body mass index at or above 25 kg/m² and type 2 diabetes who had started liraglutide, semaglutide, or tirzepatide, with more than 6 months of follow-up.

Discontinuation was defined as a gap of more than 60 days without filling a GLP-1 prescription. Reinitiation was defined as getting a new fill after that gap.

This is observational, retrospective claims data — not a randomized trial. The study identifies patterns; it cannot tell us why individuals stopped or restarted, what their outcomes were, or whether any decision was clinically appropriate for any given patient.

One more important limitation: this study covers adults with type 2 diabetes. Whether these patterns apply to people using GLP-1s for obesity without diabetes is not something this data can answer.

"Using insurance records from more than 60,000 Americans with type 2 diabetes, we found that about 4 in 10 patients stopped their GLP-1 medication within the first year, and nearly 6 in 10 had stopped by the end of two years," lead author Sontha said in the Endocrine Society press release.

That is a substantial portion of patients. But the researchers found something that often gets left out of discussions about GLP-1 adherence.

"More than half of those who stopped restarted therapy within a year (41.5%), and nearly two-thirds did so within two years (58%)," Sontha said. "This suggests that for many patients, these medications aren't being abandoned permanently; use is more start-and-stop than most people assumed."

That finding reshapes how we think about discontinuation. A patient who stops for a period — because of cost, side effects, or a change in circumstances — may not be a patient who has given up on the medication. For a meaningful portion of this group, stopping was temporary.

The researchers also found predictors of who was more likely to stop. Patients on Medicaid or Medicare, Black patients, and those experiencing nausea or other GI-related side effects (37% of discontinuers) were more likely to discontinue within a year. Patients were 10% less likely to stop if their first GLP-1 was prescribed by an endocrinologist.

These findings point to specific populations who may need more support — access barriers, side-effect management, and specialty care access are all potentially addressable.

Among the three drugs in the study, tirzepatide users were 41% less likely to discontinue than those on liraglutide. Semaglutide users were 28% less likely to stop than those on older medications.

This aligns with other real-world data suggesting newer GLP-1 medications have better persistence than older ones — likely reflecting both the magnitude of weight loss and the once-weekly dosing of newer formulations compared to the daily injection schedule of liraglutide.

What the data cannot establish is whether the improved persistence is caused by the drugs themselves, by differences in who gets prescribed them, or some combination. Tirzepatide is newer and may disproportionately be prescribed by physicians with more engagement in obesity medicine.

"This research matters because consistent use of these medications is what produces their protective effects," Sontha said. "Stopping early may mean missed opportunities to prevent heart attacks, kidney disease progression and other complications."

That framing shifts the conversation. For people with type 2 diabetes, consistent GLP-1 use carries documented cardiovascular and metabolic benefits that gaps in therapy may interrupt. Stopping is not just a weight question.

What this study does not tell us: whether the patients who stopped had good clinical reasons to (intolerable side effects, change in comorbidities), whether restarting was appropriate in their case, or what outcomes looked like for those who did or did not restart. Those are questions for prospective research and individual clinical judgment.

• What cardiometabolic and weight outcomes look like for those who stopped versus those who stayed on
• Whether stop-and-restart patterns in the T2D population mirror those in obesity-without-diabetes patients
• Whether newer GLP-1s not yet fully represented in the claims data will show different persistence patterns
• Whether reinitiation rates observed would hold in a more constrained access environment

• If I'm having side effects that make me want to stop, are there dose adjustments or timing strategies worth trying first?
• What are the specific risks of a stop-and-restart pattern given my cardiometabolic profile?
• What should the plan be if I need to stop temporarily — how do we restart safely?
• If I'm on Medicaid or Medicare and experiencing access barriers, what assistance options exist?

• Side-effect patterns driving the desire to stop — log timing, severity, and meals; many GI effects are dose- and timing-related
• Weight and metabolic markers (blood pressure, HbA1c, fasting glucose) during any break in therapy
• Duration of any gap in therapy and what triggered reinitiation — useful data for your next clinical conversation

One of the most useful things this study provides is a more honest baseline for GLP-1 treatment patterns. The data suggest something more nuanced than either "people quit because the drugs are hard to stay on" or "GLP-1 users stay on them indefinitely": stopping is common, but for a substantial portion of those who stop, it is not permanent.

Whether that pattern is medically ideal depends entirely on the individual. For people with T2D, the benefits of consistent GLP-1 use are well-established. Gaps in therapy carry real risk.

The most useful thing you can do with this information is bring it to your prescriber: not as a plan to stop when you feel like it, but as a reality to discuss and prepare for — in case you ever face cost pressure, side effects, or a gap in access. Having a plan before you need it is better than making decisions alone during a disruption.

Medical disclaimer: This content is for educational purposes only and is not medical advice. Always consult a licensed healthcare professional before starting, stopping, or changing any treatment.

Sources

• Sontha S et al. GLP-1 discontinuation and reinitiation study. Presented at ENDO 2026, Chicago, June 14, 2026. Endocrine Society press release: endocrine.org
• Renal and Urology News. "ENDO: More Than Half of Adults With T2DM Who Discontinue GLP-1 Receptor Agonists Reinitiate Treatment." https://www.renalandurologynews.com/news/endo-more-than-half-of-adults-with-t2dm-who-discontinue-glp-1-[receptor](glossary:receptor)-agonists-reinitiate-treatment/