Prescribing Patterns and Clinician Perceptions of GLP-1 Receptor Agonists Beyond Diabetes Management: A Cross-Sectional Study

Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used beyond diabetes, yet real-world prescribing behaviors and clinician perceptions remain heterogeneous, particularly regarding gastrointestinal tolerability and cardiometabolic benefit. Objective: To characterize prescribing patterns and clinician perceptions of GLP-1–based therapies beyond diabetes management and identify factors associated with beyond-diabetes prescribing. Methods: A cross-sectional clinician survey (N=160) assessed clinician characteristics, prescribing behaviors, titration strategy, gastrointestinal adverse-event (GI-AE) discontinuation, perceived benefits (weight, cardiovascular, heart failure), perceived GI risk, and implementation barriers. The primary outcome was clinician-reported prescribing beyond diabetes (yes/no). Associations were evaluated using chi-square tests and multivariable logistic regression with  odds ratios (aORs) and 95% confidence intervals (CIs). Results: Overall, 86.3% prescribed GLP-1–based therapy and 68.1% prescribed beyond diabetes. Among prescribers, 37.7% used slower-than-label titration due to GI tolerability and 28.3% reported GI-AE discontinuation in the prior 6 months. Beyond-diabetes prescribing was independently associated with formal incretin training (aOR 2.48, 95% CI 1.23–5.00) and endocrinology vs family medicine specialty (aOR 3.12, 95% CI 1.27–7.69), while higher perceived GI-AE burden (aOR 0.71 per Likert point, 95% CI 0.52–0.98) and access-barrier severity (aOR 0.66 per Likert point, 95% CI 0.44–0.98) reduced the odds of beyond-diabetes prescribing. Conclusion: Beyond-diabetes GLP-1 prescribing is common and is shaped by training and specialty context, but constrained by GI tolerability and access barriers, supporting targeted education and implementation strategies.