Ozempic-style drugs tied to lower diabetes and heart risk in prediabetes

Drugs in the same family as Ozempic, now widely used for weight loss, were linked to fewer new cases of type 2 diabetes and fewer heart attacks and strokes than metformin, the standard prevention pill, in a study of more than 250,000 adults with prediabetes and obesity.¹ The findings were announced on November 2, 2026, ahead of the American Heart Association’s Scientific Sessions in Chicago on November 6-9.¹ They come from a short research summary, called an abstract, that has not yet been peer reviewed, and the association says such findings are preliminary until published in full in a scientific journal.¹

What happened

Researchers reviewed electronic health records for 256,492 adults diagnosed with both prediabetes and obesity.¹ Prediabetes means blood sugar is above normal but not high enough for a diabetes diagnosis.¹ About half of the people in the study were taking a GLP-1 drug (the family that includes Ozempic), and the other half were taking metformin.¹ The GLP-1 drugs in the study were semaglutide, tirzepatide, liraglutide and dulaglutide.¹

Metformin is described in the announcement as the current gold-standard, first-line medicine for treating prediabetes and type 2 diabetes, along with changes to diet and activity.¹ The study author, Vinicius de Sousa Barzon Serra, a research fellow in cardiovascular medicine at the Mayo Clinic in Scottsdale, Arizona, said most earlier research on GLP-1 drugs focused on people who already had type 2 diabetes. This study looked at the earlier prediabetes stage instead.¹

The problem is common. Nearly 40% of U.S. adults have prediabetes, according to the American Heart Association, and up to 10% of them progress to type 2 diabetes each year, according to the National Institutes of Health.¹

What the records showed

Compared with people taking metformin, those taking GLP-1 drugs had:¹

• about a 1.5 times higher chance of blood sugar returning to normal levels;¹
• a 31% lower risk of developing type 2 diabetes;¹
• a 41% lower risk of dying from any cause.¹

The GLP-1 group also had 15% fewer heart attacks, 20% fewer strokes, 25% fewer cases of heart failure and 8% fewer cases of atrial fibrillation (AFib), a common type of irregular heartbeat.¹

The people studied were 52 years old on average, and 76% were women.¹ Their records came from TriNetX, a global network of electronic health records, drawing on 104 institutions between 2010 and 2023.¹ Patients were followed for roughly 3 years on average.¹ The announcement’s summary describes the lower risk of death as being over a 5-year period, while the study details give an average follow-up of about 3 years; the full paper, once published, should make clear how these fit together.¹

What it does not show yet

This was not a trial. Nobody was randomly assigned to one drug or the other. The researchers looked back at records of people whose doctors had already chosen a treatment for them.¹ In a design like this, the two groups can differ in ways the records do not fully capture, such as health habits, access to care or other conditions. That means the study can show that people on GLP-1 drugs did better on average, but it cannot prove the drugs caused the difference.

The findings are also only an abstract. The American Heart Association notes that abstracts at its meetings are not peer reviewed and are considered preliminary until a full manuscript appears in a peer-reviewed journal.¹ The available summary does not give details such as side effects, how long people stayed on their medicine, or how much weight each group lost.

An outside expert offered one possible explanation for the results. Robert Eckel, a past volunteer president of the American Heart Association and professor of medicine emeritus at the University of Colorado Anschutz Medical Campus, said the findings are not surprising.¹

“The benefits noted in this study likely relates to the patients losing weight, which is known to help prevent Type 2 diabetes,” said Eckel.

Eckel, who was not involved in the study, said GLP-1 drugs provide another option for prevention, “perhaps as an add-on therapy,” but added that “costs and access to these medications are important factors.”¹

Who is behind it

The American Heart Association describes the research as independent.¹ The work was led by Serra at the Mayo Clinic in Arizona.¹ The available summary does not name a drug company as a funder, and it does not list funding sources or conflicts of interest in the text provided to Biohack.

Serra framed the results as a topic for conversations between doctors and patients rather than a call to switch treatments.¹

“Metformin is still a first-line treatment choice. It is safe, inexpensive and has a long track record. This is less about replacing one medication with another and more about discussing additional options with specific patients,” he said.

He also said lifestyle changes to manage weight, including diet and exercise, remain an essential part of prediabetes treatment.¹ Elsewhere he said the research “may add to the case for considering GLP-1 medications earlier for certain patients, rather than waiting until they develop Type 2 diabetes.”¹

How it fits the field

These drugs are already widespread. About 1 in 10 U.S. adults may take GLP-1 medicines for blood sugar control or weight loss, according to 2026 survey information from more than 2,800 hospitals and health systems cited in the announcement.¹

Their role in heart care is also growing. A new European Society of Cardiology heart failure guideline, presented in Munich on August 28, 2026, added semaglutide or tirzepatide as an option for a type of heart failure in people with obesity (a body mass index of 30 or higher).² That recommendation was given a “IIa” grade, a level that means the treatment should be considered rather than a stronger “should be used” recommendation.²

Randomized trials, where a coin-flip decides who gets which drug, are the stronger test. One such study, PRECIDENTD, is comparing GLP-1 drugs against another drug family, SGLT2 inhibitors, in people who already have type 2 diabetes and either have heart disease or are at high risk of it.³ GLP-1 drugs in that study include Victoza, Trulicity, Ozempic and Rybelsus.⁴ The trial, sponsored by Brigham and Women’s Hospital, plans to enroll 6,000 people and is still recruiting, with its main data collection expected to finish in March 2029.³ It does not study prediabetes, so it will not directly answer the question raised by the new records study.³

What to watch next

• The full presentation. The work is due to be presented at the American Heart Association meeting in Chicago, November 6-9.¹
• A peer-reviewed paper. Until the full study is published, the numbers remain preliminary, and details such as side effects and how the groups were matched are not public.¹
• Randomized evidence in prediabetes. Large randomized trials such as PRECIDENTD focus on people who already have diabetes.³ A head-to-head trial in people with prediabetes would be the clearer test of whether these drugs prevent disease better than metformin.
• Cost and access. Eckel flagged both as important factors in whether GLP-1 drugs could be used more widely for prevention.¹

For now, the study adds a large set of real-world records to the debate over when Ozempic-style drugs should be considered. It does not settle whether starting them earlier would prevent diabetes or heart disease for any particular person.