41% of UK patients prescribed GLP-1 receptor agonists for type 2 diabetes stopped taking them within a year, and most who continued didn't reach recommended doses.
41% quit in year 1Real-world GLP-1 receptor agonist discontinuation rate among 8,200 UK diabetes patients
What the researchers found
Among 8,200 UK patients starting GLP-1 receptor agonists for type 2 diabetes, 41.1% discontinued within one year. Discontinuation was highest with oral semaglutide (55.8%), followed by subcutaneous semaglutide (46.4%), and lowest with dulaglutide (36.9%). Dose titration was frequently delayed — only 58% of semaglutide users reached recommended maintenance doses after 4 weeks, while 21% remained on starting doses.
Patients without obesity were more likely to discontinue (49.2%) than those with BMI ≥30 (37–40%). By the 10th prescription, nearly half of subcutaneous semaglutide users were still on 0.5 mg rather than the 1 mg maintenance dose. Cardiovascular disease status did not significantly affect persistence patterns.
Why it matters
Clinical trials show GLP-1 drugs work well when taken as prescribed, but this real-world data reveals that 4 in 10 UK patients stop within a year and most don't reach optimal doses. This gap between trial efficacy and real-world effectiveness is critical for understanding actual patient outcomes and healthcare planning.
The numbers in context
n=8,200 · 41.1% 1-year discontinuation · Dulaglutide 36.9% vs SC semaglutide 46.4% vs oral semaglutide 55.8% · Only 58% reached maintenance dose by week 4 · 21% stayed on starting dose
How the study worked
Population-based retrospective cohort study using UK primary care data (IQVIA Medical Research Data/THIN database). Identified 8,200 adults with type 2 diabetes who started GLP-1 RAs between March 2018 and June 2023 with at least 1 year of follow-up. Discontinuation risk was estimated using the Aalen-Johansen estimator; Cox models assessed associations with patient characteristics. Dosing trajectories were tracked across individual prescriptions.
Who was studied
8,200 UK adults with type 2 diabetes initiating GLP-1 receptor agonists in primary care (2018–2023)
What this study cannot tell us
Observational design cannot determine why patients discontinued — whether due to side effects, cost, lack of efficacy, or other reasons. UK prescribing practices may not generalize to other countries. The study period largely predates the obesity indication for semaglutide, so persistence patterns may be changing. Tirzepatide was not included as it was not yet widely available in the UK during the study period.
How to read the evidence
This is a large population-based cohort study using comprehensive UK primary care records. While observational, the large sample size and real-world setting provide valuable insights into actual prescribing patterns that clinical trials cannot capture.
When this study was published
Published in 2026 with data through 2023, this is highly current research on GLP-1 drug adherence patterns in a major healthcare system.
The bigger picture
As GLP-1 drugs become the fastest-growing drug class globally, understanding real-world adherence is critical. These findings suggest that supply issues, side effects, or prescribing caution are preventing many patients from getting the full benefit of these medications. With obesity now a major indication for these drugs, persistence patterns may be even more relevant as millions more patients start therapy.
Questions still open
- Why are oral semaglutide users discontinuing at much higher rates than subcutaneous users?
- Would patient support programs or structured dose titration protocols improve persistence?
- How do persistence patterns differ for patients using GLP-1 drugs for obesity versus type 2 diabetes?
Common questions
Why do so many people stop taking GLP-1 drugs?
Does it matter what dose of GLP-1 drug you take?
Read the original research
Real-world persistence and dose titration of GLP-1 receptor agonists in type 2 diabetes: A UK population-based cohort study by obesity and cardiovascular disease status.
Diabetes, obesity & metabolism
Citation
Ulrich, Franziska S; Napoli, Nicola; Nielsen, Morten Frost; Burden, Andrea M. (2026). Real-world persistence and dose titration of GLP-1 receptor agonists in type 2 diabetes: A UK population-based cohort study by obesity and cardiovascular disease status.. Diabetes, obesity & metabolism. https://doi.org/10.1111/dom.70535