How to Know If GLP-1 Is Right for You: Candidacy Guide

How to know if GLP-1 is right for you depends on your medical history, health goals, and specific clinical criteria. GLP-1 receptor agonists are FDA-approved medications for type 2 diabetes and chronic weight management that work by mimicking a natural hormone to regulate blood sugar and reduce appetite. Determining candidacy requires evaluating factors including body mass index, existing conditions like cardiovascular disease or kidney disease, contraindications such as thyroid cancer history, and whether you've attempted lifestyle modifications. This comprehensive guide explains who benefits most from GLP-1 therapy, what medical conditions may warrant treatment, essential questions to discuss with your doctor, and what to expect when starting these medications.

What Are GLP-1 Medications and How Do They Work?

Glucagon-like peptide-1 (GLP-1) receptor agonists are a class of medications originally developed for type 2 diabetes management and now also FDA-approved for chronic weight management in certain populations. These medications are available as injectables, with one oral option (semaglutide/Rybelsus) for diabetes treatment. They mimic the action of naturally occurring GLP-1, an incretin hormone released by the intestine in response to food intake.

GLP-1 medications work through several complementary mechanisms. They stimulate insulin secretion from pancreatic beta cells in a glucose-dependent manner, meaning insulin release occurs primarily when blood glucose levels are elevated, which reduces the risk of hypoglycemia compared to some other diabetes medications. Simultaneously, they suppress glucagon secretion from pancreatic alpha cells, further helping to regulate blood glucose. Beyond glycemic control, GLP-1 receptor agonists slow gastric emptying, which prolongs the sensation of fullness after meals and reduces appetite through central nervous system pathways.

Currently available GLP-1 medications include semaglutide (Ozempic and oral Rybelsus for diabetes, Wegovy for weight management), liraglutide (Victoza for diabetes, Saxenda for weight management), and dulaglutide (Trulicity). Tirzepatide (Mounjaro for diabetes, Zepbound for weight management) is technically a dual GLP-1/GIP receptor agonist rather than a pure GLP-1 medication. These agents differ in dosing frequency—ranging from daily to once weekly—and in their specific receptor binding profiles.

The weight loss observed with GLP-1 therapy results from reduced caloric intake due to decreased appetite and increased satiety, rather than from increased metabolism or fat burning. Clinical trials have demonstrated average weight reductions of approximately 15% with semaglutide and 15-20% with tirzepatide when combined with lifestyle modifications, though individual responses vary considerably.

Importantly, many GLP-1 medications carry a boxed warning about the risk of thyroid C-cell tumors, and they are contraindicated in patients with a personal or family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2.

Who Is a Good Candidate for GLP-1 Therapy?

Determining candidacy for GLP-1 therapy requires careful evaluation of multiple factors including medical history, current health status, treatment goals, and contraindications. The FDA has established specific criteria for both diabetes and weight management indications that guide prescribing decisions.

For type 2 diabetes, GLP-1 medications are appropriate for adults with inadequate glycemic control. According to American Diabetes Association (ADA) guidelines, GLP-1 receptor agonists may be initiated independent of metformin in patients with established atherosclerotic cardiovascular disease, high cardiovascular risk, or chronic kidney disease. They are also preferred for patients where weight loss would be beneficial or where minimizing hypoglycemia risk is a priority.

For chronic weight management, FDA approval criteria typically require a body mass index (BMI) of 30 kg/m² or greater, or a BMI of 27 kg/m² or greater with at least one weight-related comorbidity such as hypertension, dyslipidemia, or obstructive sleep apnea. Candidates should have attempted lifestyle modifications including dietary changes and increased physical activity without achieving adequate weight loss. Semaglutide (Wegovy) is also approved for adolescents aged 12 and older with obesity.

Contraindications and cautions include personal or family history of medullary thyroid carcinoma, multiple endocrine neoplasia syndrome type 2, history of pancreatitis (relative contraindication), severe gastrointestinal disease including gastroparesis, and pregnancy or planned pregnancy (GLP-1 medications should be discontinued at least 2 months before a planned pregnancy). These medications are not FDA-approved for type 1 diabetes.

Renal function considerations vary by agent—most GLP-1 medications don't require dose adjustment for kidney disease, but exenatide should be avoided in severe kidney impairment. When combined with insulin or sulfonylureas, doses of these medications often need reduction to prevent hypoglycemia. For patients taking tirzepatide, backup contraception may be needed during dose initiation and escalation due to potential interactions with oral contraceptives.

Medical Conditions That May Benefit from GLP-1 Treatment

Beyond their primary FDA-approved indications for type 2 diabetes and obesity, GLP-1 receptor agonists have demonstrated benefits across a spectrum of cardiometabolic conditions, making them particularly valuable for patients with multiple comorbidities.

Cardiovascular disease represents one of the most significant areas of benefit. Large cardiovascular outcome trials have shown that certain GLP-1 medications—specifically liraglutide, semaglutide, and dulaglutide—reduce the risk of major adverse cardiovascular events including myocardial infarction, stroke, and cardiovascular death in patients with type 2 diabetes and established cardiovascular disease or multiple cardiovascular risk factors. These benefits appear to extend beyond glucose lowering alone and may relate to improvements in blood pressure, lipid profiles, inflammation, and body weight.

Chronic kidney disease is another area where GLP-1 therapy shows promise. Recent evidence suggests these medications may slow the progression of diabetic kidney disease, reducing albuminuria and preserving estimated glomerular filtration rate (eGFR). The FLOW trial demonstrated that semaglutide significantly reduced the risk of kidney disease progression and cardiovascular death in patients with type 2 diabetes and chronic kidney disease. For patients with diabetic kidney disease and albuminuria, ADA guidelines prioritize SGLT2 inhibitors when appropriate, with GLP-1 receptor agonists as an add-on or alternative therapy.

Non-alcoholic fatty liver disease (NAFLD) and its progressive form, non-alcoholic steatohepatitis (NASH), may improve with GLP-1 treatment. Studies have shown reductions in liver fat content and improvements in liver enzyme levels, though GLP-1 medications are not FDA-approved specifically for this indication.

Additional conditions that may benefit include polycystic ovary syndrome (PCOS), where weight loss and improved insulin sensitivity can help restore ovulatory function, and obstructive sleep apnea, which often improves with significant weight reduction. Patients with prediabetes may also benefit from the weight loss and metabolic improvements, potentially delaying or preventing progression to type 2 diabetes. It's important to note that these uses are not FDA-approved indications, and benefits are primarily mediated through weight loss and improved metabolic parameters.

Questions to Ask Your Doctor About GLP-1 Therapy

Engaging in an informed discussion with your healthcare provider is essential to determine whether GLP-1 therapy aligns with your health goals and circumstances. Preparing specific questions can help ensure you understand the potential benefits, risks, and practical considerations.

Questions about appropriateness and goals:

• Based on my medical history and current conditions, am I a good candidate for GLP-1 therapy?

• What are the primary goals of treatment in my case—blood glucose control, weight loss, cardiovascular protection, or a combination?

• Are there alternative treatments we should consider first, and how do they compare?

• What realistic outcomes should I expect in terms of weight loss or A1C reduction?

Questions about safety and side effects:

• What are the most common side effects, and how can I manage them?

• Are there any serious risks I should be aware of given my medical history?

• How will this medication interact with my current medications?

• If I'm taking insulin or sulfonylureas, will those doses need adjustment to prevent low blood sugar?

• What symptoms should prompt me to contact you or seek emergency care?

• Should I be concerned about gallbladder problems, and what symptoms would indicate this?

• If I have diabetic retinopathy, how should we monitor my eye health on this medication?

• Are there any long-term safety concerns with extended use?

Questions about practical considerations:

• Which specific GLP-1 medication do you recommend for me, and why?

• How often will I need to take this medication, and what are the storage requirements?

• What is the dose escalation schedule, and how long until I reach the target dose?

• How much will this medication cost, and does my insurance cover it? Are there patient assistance programs available?

• How often will I need follow-up appointments and monitoring tests?

• What lifestyle changes should I make alongside this medication?

• If I experience intolerable side effects, what are our backup options?

• Should I stop taking this medication before any planned surgeries or procedures?

• What contraception should I use while on this medication, and when should I stop it if planning pregnancy?

Documenting your provider's responses and any specific instructions will help you make an informed decision and ensure safe, effective treatment if you proceed with GLP-1 therapy.

What to Expect When Starting GLP-1 Treatment

Beginning GLP-1 therapy involves a structured approach designed to maximize efficacy while minimizing side effects. Understanding the typical treatment course helps set realistic expectations and promotes adherence.

Initial titration and dosing: GLP-1 medications are started at a low dose and gradually increased over several weeks to months. This titration schedule allows your gastrointestinal system to adapt and significantly reduces the risk of nausea and vomiting, the most common side effects. For example, injectable semaglutide for diabetes (Ozempic) typically starts at 0.25 mg weekly for four weeks, then increases to 0.5 mg, with potential further increases as needed. For weight management, semaglutide (Wegovy) follows a similar pattern but reaches a higher target dose of 2.4 mg weekly. Oral semaglutide (Rybelsus) must be taken on an empty stomach with a small sip of water, at least 30 minutes before eating, drinking, or taking other medications. Your provider will determine the optimal pace of dose escalation based on your tolerance and response.

Common side effects and management: Gastrointestinal symptoms—including nausea, vomiting, diarrhea, constipation, and abdominal discomfort—affect up to 40-50% of patients but typically diminish over time. These can be managed by eating smaller, more frequent meals, avoiding high-fat foods, staying well-hydrated, and taking the medication on a consistent schedule. If side effects are severe, your doctor may slow the titration or temporarily reduce the dose. Injection site reactions such as redness or itching are usually mild and resolve quickly.

Warning signs to report: Contact your healthcare provider immediately if you experience severe or persistent abdominal pain (which may indicate pancreatitis), severe constipation or abdominal distension (possible ileus), right upper quadrant pain or yellowing of the skin/eyes (potential gallbladder issues), severe vomiting or inability to stay hydrated (risk of acute kidney injury), or changes in vision. If you take insulin or sulfonylureas, watch for symptoms of low blood sugar, as doses of these medications may need reduction.

Monitoring and follow-up: Regular follow-up is essential, particularly during the first few months. Your provider will monitor your weight, blood glucose levels (if you have diabetes), blood pressure, and symptoms. Initial visits may occur every 4-8 weeks, with laboratory testing including A1C, kidney function, and lipid panels as appropriate. If you have diabetic retinopathy, regular eye examinations are important, especially with rapid improvements in blood glucose control.

Perioperative considerations: Discuss with your provider whether to temporarily discontinue your GLP-1 medication before planned surgeries or procedures, as these medications can affect gastric emptying and may increase anesthesia risks.

Lifestyle modifications: GLP-1 medications are most effective when combined with dietary changes and increased physical activity. Work with your healthcare team to develop a sustainable nutrition plan and exercise routine. The appetite suppression from GLP-1 therapy can make it easier to adhere to reduced-calorie diets, but adequate protein intake and nutrient density remain important to preserve lean muscle mass during weight loss.

Frequently Asked Questions