TOPLINE

More than 6 million patients in the US initiated GLP-1 use between 2021 and 2025. The proportion of prescriptions without documented clinical indications rose steadily over that time, reaching roughly 0.74% by the end of 2025. These patients were predominantly women and White, more likely to reside in areas with lower social vulnerability, and more often covered by commercial insurance. 

METHODOLOGY

• Prior research has documented a rapid growth in GLP-1 prescribing and uneven access across demographic groups, but how often these drugs are prescribed for nonmedical reasons isn't clear.
• To investigate this, researchers used a Epic Cosmos database to analyze 6,295,965 patients (66.5% women; mean BMI, 37.7) who received a first prescription for semaglutide or tirzepatide between January 2021 and December 2025.
• The study only included patients with a medical encounter at least a year before starting the drug, and another one after starting.
• Patients without documented clinical indications were identified as those with a BMI < 27 (< 25 for Asian individuals) and no recorded diagnoses of diabetes, prediabetes, cardiovascular disease, chronic kidney disease, or other conditions for which GLP-1s are approved.
• The monthly incidence of GLP-1 prescribing within this group of patients without documented indications was tracked to assess trends over time.

TAKEAWAY

• Overall, 25,762 patients (0.4%) received GLP-1 prescriptions without a documented clinical indication; this group had a mean BMI of 25.0, and 95.1% of them were women.
• Women had nearly eightfold higher odds than men of receiving prescriptions without documented indications ( adjusted odds ratio [aOR] , 8.13; 95% CI, 7.65-8.64). White patients had nearly threefold higher odds than Black patients (aOR, 2.86; 95% CI, 2.67-3.06).
• Patients living in areas with lower social vulnerability had higher odds (social vulnerability index quartile 1 vs quartile 4: aOR, 1.67; 95% CI, 1.60-1.75). Those with commercial insurance were also more likely to receive such prescriptions than patients with Medicare (aOR, 5.69; 95% CI, 5.28-6.14).
• The proportion of GLP-1 prescriptions without documented indications rose steadily over the study period, reaching approximately 0.74% by December 2025.

IN PRACTICE

"These findings highlight the need to better understand the clinical rationale, effectiveness, and safety of GLP-1 use in populations that fall outside established regulatory indications. Professional societies may need to consider clearer guidance regarding undocumented or off label prescribing practices to ensure that access to novel treatments is aligned with clinical evidence and patient safety," the authors wrote.

SOURCE

The study was led by Chungsoo Kim, Ajou University School of Medicine, Suwon, Republic of Korea. It was published online as a research letter in Diabetes, Obesity and Metabolism.

LIMITATIONS

The study included only participating health systems, so prescribing at outside community clinics may be underrepresented. It also missed prescriptions from direct-to-consumer services, compounding pharmacies, and other external sources. Moreover, because the database does not capture treatment intent, the analysis reflected absent documentation of indications rather than prescribers' clinical reasoning.

DISCLOSURES

The authors did not report any funding. Some authors disclosed receiving research support, serving in advisory roles, holding equity, and having research contracts with a range of pharmaceutical, health technology, and research funding organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

The monthly incidence of GLP-1 prescribing within this group of patients without documented indications was tracked to assess trends over time.