GLP-1 for Prediabetes: Evidence, Eligibility, Coverage
No GLP-1 label lists prediabetes as an approved use; doctors may still prescribe one when a listed use, such as weight loss, also applies. In SURMOUNT-1, people on Zepbound lost 20.9% of body weight on average, vs 3.1% on placebo.
- Best result (SURMOUNT-1)
- 20.9% weight loss
Weight loss and half-life, side by side
Half-life in days tells you how long your body needs to clear half of one dose. The FDA label for each drug gives the figure in section 12.3.
A percentage of body weight. Trials differ, as do doses and lengths, so read each result against the placebo on its page.
Is GLP-1 approved for prediabetes?
| Medicine | For prediabetes | How it is taken | Trial result |
|---|---|---|---|
 Ozempic | Not a listed use | weekly injection | Not listed |
 Wegovy | Not a listed use | weekly injection or daily tablet | 14.9% weight loss |
 Rybelsus | Not a listed use | daily tablet | Not listed |
 Mounjaro | Not a listed use | weekly injection | Not listed |
 Zepbound | Not a listed use | weekly injection | 20.9% weight loss |
 Foundayo | Not a listed use | daily tablet | 11.1% weight loss |
 Trulicity | Not a listed use | weekly injection | Not listed |
 Saxenda | Not a listed use | daily injection | 7.4% weight loss |
 Victoza | Not a listed use | daily injection | Not listed |
| Byetta | Not a listed use | twice-daily injection | Not listed |
Sources: FDA label (DailyMed).
Who qualifies?
| Who sets the rule | Who qualifies |
|---|---|
| Ozempic | When used with diet and exercise, it lowers blood sugar in adults with type 2 diabetes. |
| Ozempic | For adults with type 2 diabetes and heart disease, the chance of heart attack, stroke or heart-related death is lower. |
| Ozempic | Adults who have chronic kidney disease and type 2 diabetes see less chance that the kidney disease gets worse, and less chance of kidney failure and heart-related death. |
| Wegovy | For adults with heart disease plus obesity or overweight, the risk of heart attack, stroke, or death related to the heart is lower (injection and tablets). |
| Wegovy | Long-term weight loss and keeping it off, through diet and activity, applies to two groups. These are people who have obesity, whether they are adults or children 12 and older, and adults who are overweight and have a weight-related condition. |
| Wegovy | It is a treatment (injection) for adults whose MASH liver disease has moderate to advanced scarring and no cirrhosis. |
| Wegovy | The tablet form is approved for adults for weight loss and heart risk. |
| Rybelsus | When used with diet and exercise, it lowers blood sugar in adults with type 2 diabetes. |
| Rybelsus | When adults with type 2 diabetes are at high risk, they face less risk of heart attack, stroke or heart-related death. |
| Mounjaro | Used with diet and exercise, it lowers blood sugar in adults and children 10 and older with type 2 diabetes. |
| Mounjaro | When adults with type 2 diabetes are at high risk, they face less risk of heart attack, stroke or heart-related death. |
| Zepbound | Through diet and activity, long-term weight loss and keeping it off applies to adults who have obesity, and also to adults who are overweight and have a weight-related condition. |
| Zepbound | It treats adults with obesity and moderate to severe obstructive sleep apnea. |
| Foundayo | Through diet and activity, long-term weight loss and keeping it off applies to adults who have obesity, and also to adults who are overweight and have a weight-related condition. |
| Trulicity | Used with diet and exercise, it lowers blood sugar in adults and children 10 and older with type 2 diabetes. |
| Trulicity | For adults with type 2 diabetes and heart disease, the chance of heart attack, stroke or heart-related death is lower or several heart risk factors. |
| Saxenda | It is for long-term weight loss and keeping it off, with diet and activity. It covers children 12 and older (over 60 kg) and adults who have obesity, plus adults who are overweight and have a weight-related condition. |
| Victoza | Used with diet and exercise, it lowers blood sugar in adults and children 10 and older with type 2 diabetes. |
| Victoza | For adults with type 2 diabetes and heart disease, the chance of heart attack, stroke or heart-related death is lower. |
| Byetta | When used with diet and exercise, it lowers blood sugar in adults with type 2 diabetes. |
| Medicare GLP-1 Bridge | BMI 35 or higher, no condition needed |
| Medicare GLP-1 Bridge | Coverage needs a BMI of 30 or above, plus heart failure, uncontrolled blood pressure, or CKD 3a+ |
| Medicare GLP-1 Bridge | A BMI of 27 or above, plus PAD, prediabetes, or a previous heart attack or stroke |
| Typical commercial plan (Aetna policy) | BMI 30 or higher |
| Typical commercial plan (Aetna policy) | BMI 27 or higher with a weight-related condition |
| Typical commercial plan (Aetna policy) | first, on a diet and activity program for 6 months |
Trial results in prediabetes
None of these trials enrolled only prediabetes; the people studied were adults with obesity or overweight, without diabetes, adults with obesity or overweight, and no type 2 diabetes and adults with obesity, without type 2 diabetes.
| Trial | Medicine | Who took part | Length | People | Main result | Comparison |
|---|---|---|---|---|---|---|
| STEP 1 | Wegovy | Adults with obesity or overweight, without diabetes | 68 weeks | 1,961 | 14.9% weight loss | 2.4% on placebo |
| OASIS 4 | Wegovy | Adults with obesity or overweight, without diabetes | 64 weeks | 307 | 13.6% weight loss | 2.4% on placebo |
| SURMOUNT-1 | Zepbound | Adults with obesity or overweight, without diabetes | 72 weeks | 2,539 | 20.9% weight loss | 3.1% on placebo |
| SURMOUNT-5 | Zepbound | Adults with obesity, without type 2 diabetes | 72 weeks | 751 | 20.2% weight loss | Not listed |
| SCALE Obesity and Prediabetes | Saxenda | Adults with obesity or overweight, and no type 2 diabetes | 56 weeks | 3,731 | 7.4% weight loss | 3% on placebo |
| ATTAIN-1 | Foundayo | Adults with obesity or overweight, without diabetes | 72 weeks | 3,127 | 11.1% weight loss | 2.1% on placebo |
Trial sources: STEP 1 (FDA label (DailyMed)), SURMOUNT-1 (FDA label (DailyMed)), SURMOUNT-5 (PubMed), SCALE Obesity and Prediabetes (FDA label (DailyMed)), ATTAIN-1 (FDA label (DailyMed)).
What is different when you have prediabetes?
| What changes | What the label says | Labels |
|---|---|---|
| Hypoglycemia When Using Insulin Secretagogues or Insulin at the Same Time | Low blood sugar is more likely when you take it with insulin or a sulfonylurea, so those doses may need to be lowered. | All of them |
| Taken with insulin or sulfonylureas | When you combine this medicine with insulin or a sulfonylurea, such as glipizide or glimepiride, low blood sugar is more likely. Your doctor may lower those doses. | All of them |
Taken from the FDA labels: FDA DailyMed label.
These come from the label warnings: FDA label (DailyMed).
Coverage for prediabetes
Medicare Part D does not pay for a GLP-1 when you take it only for weight loss.
The Medicare GLP-1 Bridge puts Wegovy at $50 a month for people who meet its rules.
Where Medicaid pays for weight-loss GLP-1s, prior authorization is the norm.
These sources come from humana.com, CMS, KFF.
- Ozempic Coupon
- Ozempic Cost
- Ozempic Cost Without Insurance
- Ozempic Cost With Insurance
- Is Ozempic Covered by Insurance? Criteria, Copay, Appeal
- Does Medicare Cover Ozempic? Part D Rules and the GLP-1 Bridge
- Ozempic Patient Assistance
- Cheapest Way to Get Ozempic
- Does Medicaid Cover Ozempic? Criteria, Copay, How to Appeal
Questions to ask your prescriber
- For coverage purposes, does my prediabetes count as a weight-related condition?
- Is a weight-loss brand a better fit for me than one for diabetes?