Administration errors and dosing problems account for 63% of GLP-1 adverse event reports — far higher than for insulin — with a surge coinciding with 2022-2024 drug shortages.
63% administration-related adverse eventsNearly two-thirds of FDA adverse event reports for GLP-1 receptor agonists involved administration errors or dosing problems — substantially higher than the 39% rate for injectable insulin, suggesting the rapid adoption of these drugs has outpaced patient education.
What the researchers found
Among 112,532 FDA adverse event reports analyzed from 2015-2024, GLP-1 receptor agonists were associated with a much higher share of administration-related reactions (63%) compared to injectable insulin (39%). Reports of dosing issues and administration errors for GLP-1s increased starting in Q4 2022 and continued rising through 2023 and 2024 — a pattern not seen for insulin. This increase coincided temporally with national GLP-1 drug shortages that began in March 2022.
Why it matters
The explosive growth of GLP-1 prescribing has created a unique safety situation: a high proportion of adverse events aren't from the drug's pharmacological effects but from errors in how people use the injection devices, mix doses, or handle administration. The temporal link to drug shortages suggests that supply chain disruptions — leading to dose switching, compounded products, or unfamiliar devices — may be driving these errors. This has major implications for patient education and regulatory oversight.
How the study worked
Cross-sectional analysis of publicly available FDA Adverse Event Reporting System (FAERS) data from January 2015 through December 2024. Reports where GLP-1 receptor agonists were the primary suspect were identified and compared with reports involving injectable insulin products. Administration-related reactions, dosing issues, and temporal trends were analyzed quarterly.
Who was studied
112,532 FDA adverse event reports involving GLP-1 receptor agonists or injectable insulin from January 2015 to December 2024
What this study cannot tell us
FAERS is a voluntary reporting system that lacks exposure denominators (total number of prescriptions), so increased reports may reflect increased utilization rather than increased risk. The temporal correlation with GLP-1 shortages is observational and does not prove causation. The study cannot distinguish between errors with branded products versus compounded GLP-1 preparations. Specific GLP-1 agents are not differentiated in the abstract.
How to read the evidence
This is a cross-sectional analysis of FAERS data, which provides large-scale safety signal detection but has inherent limitations including voluntary reporting, lack of denominators, and inability to establish causation. The temporal patterns are suggestive but observational. Published in Health Affairs Scholar, a respected health policy journal.
When this study was published
Published in 2026 with data through December 2024, this is an extremely current analysis capturing the full trajectory of the GLP-1 usage explosion and the associated supply shortages.
The bigger picture
This study highlights an underappreciated dimension of the GLP-1 revolution: as these drugs reach mass-market scale, the challenges shift from pharmacological safety to practical usability. The finding that most adverse events are administration-related — not drug-related — suggests that better device design, patient education, and pharmacist support could prevent the majority of reported problems. The temporal link to supply shortages also raises concerns about the safety of compounded GLP-1 preparations, which surged during shortage periods.
Questions still open
- How many of the administration errors during shortages involved compounded GLP-1 preparations versus branded products?
- Would standardized injection training programs for GLP-1 initiators reduce the disproportionate rate of administration errors?
- Are the administration error rates higher for patients who obtain GLP-1s through telehealth platforms without in-person instruction?
Common questions
Why do GLP-1 drugs have more administration errors than insulin?
Did the drug shortages directly cause more side effects?
Read the original research
Adverse events administering glucagon-like peptide-1 receptor agonists: a cross-sectional study.
Health affairs scholar, 4(2), qxag023
Citation
Mattingly, T Joseph; Duru, Emeka Elvis; Conti, Rena M. (2026). Adverse events administering glucagon-like peptide-1 receptor agonists: a cross-sectional study.. Health affairs scholar, 4(2), qxag023. https://doi.org/10.1093/haschl/qxag023