Thurs 2026/09/24 GLP-1 Receptor Agonists Beyond Glucose and Weight
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An approach dive on what GLP-1 receptor agonists actually do beyond glucose and weight, built to answer the question Monday's sweep left open — that the evidence for anything harder than weight loss is thin. It starts with a new FPIN help desk answer in the August American Family Physician on GLP-1s and stroke prevention, and uses its second cited study as a worked example of immortal time bias and the healthy-user effect, since the study reports that urinary tract infections and candidiasis were less common in drug users, which no drug does. It then walks the outcome trials one at a time with PICO — SELECT for cardiovascular prevention without diabetes, FLOW for kidney disease, SOUL for oral semaglutide, STEP-HFpEF for heart failure with preserved ejection fraction, and STRIDE for peripheral artery disease — decomposing the composite endpoints to show which component is carrying each result. It closes on SURPASS-CVOT and the August 2026 FDA approval of tirzepatide for cardiovascular risk reduction, which is the first of these granted on noninferiority to an active comparator rather than superiority to placebo, and on the NAION labeling change European regulators made in June 2025.