A new study suggests that people with Type 2 diabetes who stop taking popular GLP-1 medications may face twice the risk of a heart attack, stroke or death compared with those who continue treatment, raising questions about the potential consequences of interrupting the drugs. The study, which examined health records from more than 80,000 people with Type 2 diabetes in Italy, found that patients who discontinued GLP-1 receptor agonists (GLP-1 RAs) had a significantly higher risk of experiencing a major cardiovascular event or dying from any cause. Researchers analyzed data collected between 2004 and 2024 from 301 diabetes clinics across Italy. Of the 80,302 patients included in the study, 60.5 per cent had discontinued their medication by their last recorded visit. After accounting for differences between patients, researchers found that those who stopped treatment had approximately twice the risk of experiencing a combined outcome of a non-fatal heart attack, non-fatal stroke or death from any cause compared with those who remained on the medication. The risk of death from any cause was also substantially higher among those who discontinued treatment. However, in an interview with CTVNews.ca on Wednesday, cardiologist and epidemiologist Dr. Christopher Labos said the findings should be interpreted carefully because the research was observational and cannot establish that stopping the medications directly causes heart attacks or strokes. Why stopping treatment matters GLP-1 medications, including Ozempic, are used to treat Type 2 diabetes by helping regulate blood sugar. They can also promote weight loss and provide cardiovascular benefits. Labos says the findings are consistent with what is already known about the medications and their protective effects. “When you stop your diabetes medications, your blood sugar goes up, that then increases your risk of not just heart attack, but also stroke and all the other complications with diabetes,” he said. He cautioned against interpreting the findings as proof that stopping the drugs itself triggers cardiovascular events. “I don’t think it’s that stopping these drugs is causing the heart attacks. I think it’s that continuing these drugs lowers it,” Labos said. Side effects remain a major reason patients quit The study notes that discontinuation is common in routine clinical practice, with gastrointestinal side effects, cost and inconvenience among the reasons people stop treatment. Labos says shortages that affected access to the medications earlier have largely eased, while the cost of some treatments has also become less of a barrier in Canada. “The biggest reason why people stop these medications are the gastrointestinal side effects,” he said. Nausea and digestive discomfort can be particularly difficult when patients first begin treatment. Labos says gradually increasing the dosage over several weeks, rather than starting at a higher dose, can make the side effects more manageable. What should patients do if they cannot tolerate GLP-1 drugs? Labos stresses that GLP-1 medications are not the only option available to people with Type 2 diabetes. Other treatments, including less expensive oral medications such as metformin, can help patients manage their blood sugar. Lifestyle changes, including healthier eating and regular exercise, can also play an important role. “If you were prescribed this medication and you cannot take it because of side effects, I think that’s fine. Talk to your pharmacist, talk to your doctor, and start something else. There are many alternative diabetes medications out there,” he said. “The most important thing is to get your blood sugar under control.” The study also found that the association between discontinuation and cardiovascular outcomes was more pronounced among patients with obesity. Researchers acknowledged several limitations, including the observational nature of the study, which means other health conditions or factors may have influenced patients’ decisions to stop treatment and their subsequent outcomes. Labos says patients experiencing side effects should not simply abandon treatment without discussing alternatives with their health-care providers.
