Persistence in GLP-1–Based Therapy Among Adults with Obesity and Type 2 Diabetes: A Narrative Review of Definitions, Real-World Outcomes, and Determinants

Abstract

Abstract Purpose of Review Persistence with glucagon-like peptide-1 (GLP-1)–based therapies is important for sustained weight loss and glycemic control in adults with coexisting obesity and type 2 diabetes. This narrative review examined how persistence has been defined and measured, real-world patterns of continuation and discontinuation, factors associated with persistence, reasons for discontinuation, and supportive strategies in this population. Recent Findings Seven studies met the inclusion criteria, with follow-up ranging from 6 months to 2 years. Persistence generally declined over time and often fell below 60% by 12 to 24 months, although estimates varied by refill-gap definitions and analytic approaches. Discontinuation reached 64.1% at 2 years in one large cohort, and treatment interruption with reinitiation was common. Persistence varied by age, income, gastrointestinal adverse events, weight reduction, body mass index–related measures, GLP-1 agent, formulation, and dosing schedule. Only two studies reported patient-level reasons for discontinuation, most commonly adverse effects, and none described structured behavioral or supportive strategies. Summary Persistence with GLP-1–based therapies among adults with obesity and type 2 diabetes is variable and often declines within the first one to two years. More consistent definitions, closer attention to patient experiences, and routine-care support strategies are needed to improve long-term continuation.