BACKGROUND: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a modern class of medications initially approved for type 2 diabetes mellitus (T2DM) but now also widely used for obesity. Although these drugs offer significant benefits for glycemic control, weight loss, and cardiorenal health, studies consistently show a pronounced sex difference in their use. However, there is a scarcity of studies addressing the factors responsible for these sex differences in GLP-1RA utilization in the United States.
OBJECTIVE: To examine time- and sex-specific factors associated with GLP-1RA utilization among US adults before and after the landmark approval of semaglutide for chronic weight management.
METHODS: We analyzed data from the 2019-2022 Medical Expenditure Panel Survey, a nationally representative survey of US adults (aged ≥18 years). GLP-1RA use was identified via prescription drug files. Descriptive statistics and chi-square tests compared characteristics of GLP-1RA users by time and sex. Multivariable logistic regression models estimated associations between individual characteristics and GLP-1RA use, both overall and among time- and sex-stratified cohorts. Subgroup analysis was conducted in adults with T2DM.
RESULTS: The weighted prevalence of GLP-1RA use increased significantly from 6,158,326 (0.47%) in 2019-2020 to 10,410,021 (0.79%) in 2021-2022 ( < 0.0001). The rate of use was 0.48% and 0.46% in women and men, respectively, in 2019-2020 ( = 0.837) and increased to 0.82% in women and 0.76% in men in 2020-2022 ( = 0.964). T2DM was the strongest predictor of GLP-1RA use (odds ratio [OR] = 56.1 [2019-2020] and OR = 32.7 [2021-2022]), but the proportion of users with T2DM slightly decreased over time (92.8% in 2019-2020 to 90.2% in 2021-2022 [ = 0.239]). This decrease was especially pronounced in women during the 2021-2022 period, with men exhibiting a notably higher proportion of T2DM patients (94.4%) compared with women (86.2%) ( = 0.002). The proportion of users with obesity increased significantly (5.3% to 9.2%, = 0.024), nearly doubling among female users (4.9% to 10.6%). The association with obesity strengthened over time (OR = 1.85 to 5.59), especially among women (OR: 6.43 vs 2.04 in men). Among women, depression was linked to greater use. In patients with T2DM, the use of insulin and oral antidiabetic medications was associated with higher GLP-1RA utilization. P P P P P P
CONCLUSIONS: This study confirms the increasing utilization of GLP-1RAs in the United States, particularly among women. Although type 2 diabetes remains the primary predictor of GLP-1RA use, obesity has emerged as a key associated factor, especially among women. The stronger associations observed in women with obesity and depression highlight the role of clinical and psychosocial factors, which underscores the need for sex-sensitive approaches in obesity and diabetes management.
