Nutritional deficiencies and muscle loss in adults with type 2 diabetes using GLP-1 receptor agonists: A retrospective observational study

W Scott Butsch; Suela Sulo; Andrew T Chang; Jeeyun A Kim; Kirk W Kerr; Dominique R Williams; Refaat Hegazi; Thadchaigeni Panchalingam; Scott Goates; Steven B Heymsfield

doi:10.1016/j.obpill.2025.100186

Nutritional deficiencies and muscle loss in adults with type 2 diabetes using GLP-1 receptor agonists: A retrospective observational study

Obes Pillars. 2025 Jun 10:15:100186. doi: 10.1016/j.obpill.2025.100186. eCollection 2025 Sep.

Authors

Affiliations

¹ Cleveland Clinic, Bariatric and Metabolic Institute, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
² Medical Affairs and Research, Abbott Nutrition, 100 Abbott Park Rd, Abbott Park, IL, 60064, USA.
³ Global Data Science and Analysis, Abbott Medical Devices, 3200 Lakeside Dr, Santa Clara, CA, 95054, USA.
⁴ Global Data Science and Analysis, Abbott Medical Devices, 15900 Valley View Court, Sylmar, CA, 91342, USA.
⁵ Medical Affairs and Research, Abbott Nutrition, 2900 Easton Square Pl, Columbus, OH, 43219, USA.
⁶ Pennington Biomedical Research Center, Louisiana State University, 640 Perkins Rd, Baton Rouge, LA, 70808, USA.

Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) drug-induced weight loss is associated with fat mass reduction but can also lead to nutritional deficiencies and loss of muscle. We quantified nutritional deficiencies in adults who had undergone GLP-1RA treatment.

Methods: This was an observational, retrospective analysis of de-identified patient-level claims data from 461,382 adults newly prescribed GLP-1RAs between 7/2017 and 12/2021 with no prior diagnoses of nutritional deficiencies. While most patients had type 2 diabetes (T2DM), the population also included individuals with type 1 diabetes (T1DM), prediabetes, or no recorded diabetes diagnosis. A secondary propensity-matched analysis compared GLP-1RA users with non-users. The matched comparator cohort consisted of adults with type 2 diabetes treated with metformin but not prescribed GLP-1RAs, whereas GLP-1RA users were treated with both metformin and GLP-1RA. Nutritional deficiencies were assessed at 6 and 12 months after GLP-1RA initiation. Nutritional deficiency diagnoses or complications were compared between patients with or without a dietitian visit within a 6-months of treatment initiation.

Results: Patients were mainly female (56.3 %), mean age (±SD) 52.9 (±11.7) years, with obesity (44.9 %) or overweight (5.6 %); type 2 diabetes (80.5 %) and hypertension (66.3 %) were the most common comorbidities. Nutritional deficiencies were diagnosed in 12.7 % of the patients within 6 months after GLP-1RA initiation and in 22.4 % within 12 months. Vitamin D deficiency was most common, having an incidence of 7.5 % and 13.6 % within 6 and 12 months, respectively. Recorded nutrient deficiencies or deficiency-related complications were more likely among patients with a dietitian visit within the first 6 months of GLP-1RA initiation compared to patients without a dietitian visit.

Conclusion: Over 20 % had nutritional deficiencies diagnosed within one-year of starting GLP-1RA treatment. These findings highlight the importance of nutritional screening and diagnosis of deficiencies and inclusion of physician nutrition specialists, dietitians, and other nutrition care specialists in patient care.

Keywords: Dietitian; Glucagon-like peptide-1 receptor agonists; Nutritional deficiency; Obesity; Overweight; Type 2 diabetes.