GLP-1 receptor agonist indications and prescriptions among adults who do and do not smoke
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Background
Smoking and obesity are leading causes of preventable morbidity and mortality, often co-occurring and synergistically increasing risks for cardiovascular disease and diabetes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are effective for managing type 2 diabetes, obesity, and cardiovascular disease, and emerging evidence suggests potential benefit for smoking cessation. However, the prevalence of GLP-1 RA indications and prescriptions among adults who smoke is unknown.
Objective
To compare the frequency of GLP-1 RA indications and prescriptions among adults who do and do not smoke within a large Midwest health system.
Methods
Electronic health record data identified adults (≥18 years) with outpatient primary care visits from September 2023–2024. Patients were categorized as current smokers or non-smokers. We assessed indications for GLP-1 RAs—type 2 diabetes, weight management (BMI ≥30 or 27– 29.9 with comorbidity), and secondary prevention of cardiovascular disease and examined prescription rates among those with at least one indication.
Results
Of 59,981 patients, 4,843 (8.1%) were current smokers. Compared to non-smokers, adults who smoke were more likely to have an indication for GLP-1 RAs (66.1% vs. 62.6%; p <0.001) but less likely to receive a prescription (20.4% vs. 23.2%; p <0.001). This pattern was consistent across all indications.
Conclusion
Adults who smoke more frequently meet clinical criteria for GLP-1 RAs yet are less likely to be prescribed these therapies. Enhancing access to GLP-1 RAs for individuals who smoke could address critical metabolic and smoking-related health challenges, particularly given their potential role in supporting smoking cessation.
