The use of GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists has expanded significantly in diabetes care. Their proven efficacy in lowering blood glucose levels, promoting weight loss, improving cardiovascular outcomes, and providing kidney protection has contributed to their popularity.
GLP-1 Therapy Often Stopped Within One Year
However, research shows that over one-third of individuals with diabetes discontinue these medications within one year.1 A 2024 JAMA study, which did not include the newest incretin tirzepatide, identified key factors contributing to this trend.
Discontinuation rates were significantly higher among individuals with increased out-of-pocket costs, those from Black or Hispanic populations, individuals with more significant social needs, and those experiencing gastrointestinal intolerances.1
Education and support, frequency of follow-up visits after therapy initiation, and proactive management of gastrointestinal symptoms are recommended to enhance therapy tolerance and increase the likelihood of continued use. Understanding effective strategies to manage gastrointestinal side effects is essential for symptom mitigation in individuals on incretin therapy.
Managing Side Effects
Gastrointestinal intolerance (GI) occurs in 10-30% of individuals taking incretin medications2 and symptoms are typically transient, most noted after an increase in dose. Dose modifications and extending dose titration timing are recommended for individuals with persistent GI symptoms. In addition, the ADA 2025 Standards of Care recommends counseling on dietary modifications to mitigate GI side effects3, and a referral to a dietitian is recommended for individuals needing advanced support.4
Nausea is the most reported GI side effect. Diabetes Care and Education Specialists (CDCES) can encourage the pacing of meals, eating smaller portions, awareness of fullness, and avoiding high-fat or spicy foods. In some cases, consuming easy-to-digest, bland foods such as crackers, apples, mint, or ginger-based products and avoiding strong smells may provide relief.2
Diabetes educators can also advise individuals to stay upright after meals, including adequate hydration but avoiding rapid fluid intake (avoid the use of straws) to prevent exacerbating symptoms. If symptoms persist, coordination with a prescriber to consider anti-nausea or prokinetic agents and assessment of medication dosing may support symptom reduction.2
Vomiting and diarrhea, while less common than nausea, can impact quality of life and if severe may pose health risks. For vomiting, it is important to ensure adequate hydration, and use strategies discussed above to support nausea reduction. Emphasizing broths, liquids, and lower-fiber foods can also help until symptoms resolve. For diarrhea, it is essential to identify and avoid trigger foods and beverages such as sugar alcohols, isotonic sports drinks, coffee, alcohol, carbonation, and high-lactose foods.3 Including soluble fiber food sources can help with diarrhea symptoms. Healthcare professionals can work with prescribers to consider anti-emetic medications, a slower titration schedule, or discontinue therapy if symptoms persist.
Unlike nausea and vomiting, constipation symptoms may occur as a more chronic condition. The reduction in thirst caused by incretins may exacerbate this symptom. Strategies to support increased fluid intake, a minimum of 64 oz per day, are recommended. Dietary intervention strategies such as increasing dietary fiber intake from fruits, vegetables, and whole grains and promoting regular physical activity are key interventions.3 For individuals experiencing persistent constipation, a fiber supplement, stool softener, or laxative may be considered.
Role of Diabetes Care and Education Specialists
Diabetes care and education specialists, play a crucial role in supporting people using GLP-1 or GIP/GLP-1 RA medications. Referring individuals to a Registered Dietitian Nutritionist can provide personalized recommendations based on each patient’s symptoms and dietary patterns.
Working together in a team approach for lifestyle and medication management can reduce symptoms effectively. We can offer support for communities at risk of therapy discontinuation. Through education about common side effects, and providing practical strategies to manage symptoms, we can improve medication continuity and enhance long-term treatment success.
References
- Do D, Lee T, Peasah SK, Good CB, Inneh A, Patel U. GLP-1 Receptor Agonist Discontinuation Among Patients With Obesity and/or Type 2 Diabetes. JAMA Netw Open.2024;7(5):e2413172. doi:10.1001/jamanetworkopen.2024.13172
- Gorgojo-Martínez JJ, Mezquita-Raya P, Carretero-Gómez J, Castro A, Cebrián-Cuenca A, de Torres-Sánchez A, García-de-Lucas MD, Núñez J, Obaya JC, Soler MJ, Górriz JL, Rubio-Herrera MÁ. Clinical Recommendations to Manage Gastrointestinal Adverse Events in Patients Treated with Glp-1 Receptor Agonists: A Multidisciplinary Expert Consensus. J Clin Med. 2022 Dec 24;12(1):145. doi: 10.3390/jcm12010145. PMID: 36614945; PMCID: PMC9821052.
- American Diabetes Association Professional Practice Committee; Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes—2025. Diabetes Care1 January 2025; 48 (Supplement_1): S181–S206. https://doi.org/10.2337/dc25-S009
- Gigliotti, Linda et al. Incretin-Based Therapies and Lifestyle Interventions: The Evolving Role of Registered Dietitian Nutritionists in Obesity Care. Journal of the Academy of Nutrition and Dietetics, Volume 125, Issue 3, 408 – 421
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