Do GLP-1s Really Help Type 2 Diabetes Patients Stop Insulin?

Achieving insulin discontinuation represents a major goal for many individuals managing type 2 diabetes (T2D). Furthermore, daily injections often impose a substantial psychological and physical burden. Consequently, clinicians constantly seek effective strategies to help patients safely transition off basal insulin. Specifically, researchers investigated whether adding glucagon-like peptide-1 receptor agonists (GLP-1RAs) could facilitate this process more effectively than oral agents.

Evaluating Rates of Insulin Discontinuation

In a recent target trial emulation, investigators analyzed clinical records from the U.S. Veterans Health Administration. They compared patients initiating a GLP-1RA, an SGLT-2 inhibitor (SGLT-2i), or a DPP-4 inhibitor (DPP-4i). Additionally, all included participants were already receiving basal insulin. The primary outcome was successful insulin discontinuation, defined as a gap in insulin fills of 12 months or more. In fact, the analysis revealed similar discontinuation rates across all groups. Indeed, about 16.7% of GLP-1RA users stopped insulin, compared to 17.9% for SGLT-2is and 17.1% for DPP-4is.

Understanding the Real-World Implications

These findings challenge the common belief that GLP-1RAs provide an easier path off insulin. Consequently, clinicians must recognize that adding these agents does not guarantee stopping insulin. Furthermore, several real-world barriers might explain these findings. For example, fewer than 10% of patients reached the maximum dose of their GLP-1RA during follow-up. Additionally, high treatment crossover rates occurred during the study. Therefore, clinicians should focus on holistic cardiovascular and metabolic benefits rather than expecting automatic insulin discontinuation.

Frequently Asked Questions

Q1: Did adding GLP-1RAs result in higher rates of insulin discontinuation compared to other oral therapies?

No, the study showed no significant difference in insulin discontinuation rates. Specifically, approximately 16.7% of GLP-1RA initiators stopped insulin, compared to 17.9% of SGLT-2i initiators and 17.1% of DPP-4i initiators.

Q2: Why might real-world results differ from clinical trial expectations?

Several real-world factors may limit discontinuation rates. For example, less than 10% of patients in this study reached the maximum dose of their GLP-1RA. Additionally, high rates of medication crossover during follow-up could have obscured potential differences.

Q3: Should clinicians stop prescribing GLP-1RAs to patients on basal insulin?

Certainly not. However, they continue to offer proven benefits for weight management, cardiovascular protection, and renal health in type 2 diabetes.

References

1. Lipska KJ et al. Comparative Effectiveness of Glucagon-like Peptide-1 Receptor Agonists Versus Oral Agents for Insulin Discontinuation in Type 2 Diabetes : A Target Trial Emulation. Ann Intern Med. 2026 Jul 14. doi: 10.7326/ANNALS-25-05216. PMID: 42441965.
2. Monaco K. Study Dampens Hope for GLP-1s as Insulin Off-Ramp in Type 2 Diabetes. MedPage Today. 2026 Jul 13.