Public interest in GLP‑1 receptor agonists has exploded in recent years. These medicines, known as GLP‑1 RAs, include drugs like semaglutide, liraglutide, and dulaglutide.
Many people recognize the brand names Ozempic and Wegovy, which became famous for helping people lose weight. But these drugs were originally created to help people with type 2 diabetes control their blood sugar.
Because they all work in a similar way but have slightly different chemical structures, researchers have wondered whether these differences might affect patient safety.
A new study led by clinical pharmacist and researcher Catherine “Katie” Derington from the University of Colorado looked closely at this question. Her team studied the health records of 21,790 U.S. veterans with type 2 diabetes.
They compared three GLP‑1 drugs—liraglutide, semaglutide, and dulaglutide—to see if any of them carried different risks for the heart, kidneys, or overall death.
The results were reassuring. Overall, all three medicines showed low risks. This is good news, especially because generic versions of liraglutide are becoming available, which may make treatment more affordable for many people. However, the researchers note that more studies are needed to confirm these findings in different groups of people.
To understand why this study matters, it helps to know how common diabetes is. More than 38 million Americans have diabetes, and 90% to 95% of them have type 2 diabetes. Over time, this condition raises the risk of heart disease and kidney disease.
Heart disease is a leading cause of death in people with diabetes. This is why doctors today focus on something called cardiovascular‑kidney‑metabolic (CKM) syndrome. It recognizes that diabetes, heart disease, and kidney disease are deeply connected and must be treated together.
GLP‑1 drugs have become “blockbuster drugs” partly because they do more than just lower blood sugar. Studies have shown they can improve heart and kidney health too.
The FDA has approved liraglutide, semaglutide, and dulaglutide to help prevent heart problems in people with diabetes. So far, only semaglutide is approved to slow kidney disease in people who already have kidney problems.
Even though these drugs are widely used, there had never been a head‑to‑head comparison of their safety. Derington’s team wanted to fill that gap. They used the Veterans Affairs (VA) health system, which has a huge amount of detailed medical data.
After analysing the records, the researchers found that the three drugs showed very similar safety profiles. This means most patients can feel confident using whichever medicine is available or affordable.
However, the study also found a few small differences. Liraglutide appeared to have a lower risk of death from any cause compared to dulaglutide. This was surprising because both drugs protect against heart disease. It’s unclear whether this difference is real or due to other factors, and more research is needed.
Another difference was that semaglutide showed a slightly higher risk of gallstones. Researchers don’t yet know why this happens, but the overall number of cases was very small. Derington says that these events were rare and should not frighten patients.
Instead, she suggests that people choosing between the drugs should think about cost, insurance coverage, and how often the medicine needs to be taken.
Although the findings are encouraging, the researchers stress that more studies are needed. The VA population consists mostly of older white men, so results must be confirmed in more diverse groups. Randomized clinical trials—where patients are assigned to medicines by chance—are also needed to prove cause and effect more clearly.
The field of diabetes treatment is also changing quickly. Newer drugs like tirzepatide work on two hormone receptors instead of one and may be even more powerful.
Another drug in development, retratrutide, works on three receptors and may offer even broader benefits. As more of these advanced drugs become available, researchers will need to compare their safety and effectiveness to older GLP‑1 medicines.
In reviewing this study, the main message is clear: current GLP‑1 drugs appear to be safe and equally effective for most people with type 2 diabetes. While there were a few small differences, none were serious enough to change treatment for most patients.
This study brings comfort to both patients and doctors, showing that these popular medicines are more alike than different. Still, ongoing research will be important to confirm the results and guide future treatment choices.
If you care about diabetes, please read studies about Vitamin D and type 2 diabetes, and to people with diabetes, some fruits are better than others.
For more health information, please see recent studies that low calorie diets may help reverse diabetes, and 5 vitamins that may prevent complication in diabetes.
The study is published in JAMA Network Open.
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