Incretin Therapy: Patient Selection Guide
- The use of incretin-based therapies is rapidly growing, fueled by a greater understanding of how they work, their effectiveness in improving metabolic health and widening approval for different...
- At the 2025 National Lipid Association (NLA) Scientific Sessions, Dr.
- Abushamat noted that new therapies, such as retatrutide, a triple agonist, are under inquiry and achieving results comparable to bariatric surgery.
Incretin therapies show promise for obesity management, but proper patient selection is vital. this News Directory 3 article unpacks expert recommendations, emphasizing that factors like tolerability, access, adn cost heavily influence success. This in-depth patient selection guide details the rising use of incretin-based treatments and highlights the expanded FDA approvals for conditions beyond type 2 diabetes. Learn why BMI isn’t the only metric for obesity and explore how patient-centered care is key. Discover what’s next in the expanding world of incretin therapies.
Experts Highlight Patient Selection for incretin Therapies in Obesity Management
Updated June 2, 2025
The use of incretin-based therapies is rapidly growing, fueled by a greater understanding of how they work, their effectiveness in improving metabolic health and widening approval for different uses.Pharmacists are key in applying this knowledge, ensuring the right patients get these treatments, are well-informed and properly managed.
At the 2025 National Lipid Association (NLA) Scientific Sessions, Dr. Layla Abushamat of Baylor collage of Medicine reviewed incretin biology, the expanding therapeutic indications of glucagon-like peptide 1 (GLP-1) receptor agonists, and combination therapies for managing obesity.
Abushamat noted that new therapies, such as retatrutide, a triple agonist, are under inquiry and achieving results comparable to bariatric surgery.
Incretin therapies are seeing broader FDA-approved uses. While all GLP-1 receptor agonists treat type 2 diabetes, some also address atherosclerotic cardiovascular disease (ASCVD) in those with type 2 diabetes. Liraglutide, semaglutide and tirzepatide are approved for overweight and obesity; semaglutide is also indicated for obesity with ASCVD, and tirzepatide for obesity with obstructive sleep apnea.
Research suggests potential future uses for metabolic dysfunction-associated steatotic liver disease,heart failure and chronic kidney disease.
According to a National Health and Nutrition Examination Survey analysis, over half of U.S. adults—about 140 million people—meet the criteria for incretin therapy based on current approvals. Abushamat emphasized the importance of carefully selecting, engaging and monitoring patients.
Beyond BMI
Abushamat saeid that while body mass index (BMI) is standard in clinical trials and approvals, it’s not perfect. BMI cutoffs (≥27 kg/m for overweight with comorbidities, ≥30 kg/m for obesity) are based on associations with mortality and cardiometabolic risk mainly in white populations and may not accurately reflect risk in other groups.
She noted that while a BMI over 30 indicates obesity in about 42% of Americans, these definitions vary by age, sex, race and ethnicity. Anti-obesity medications were studied using these definitions, so a BMI of 27 or greater with a weight-related comorbidity, or a BMI of 30 or greater, qualifies someone for therapy. Though, these measures aren’t ideal for every patient.
Abushamat explained that race and ethnicity significantly affect these cutoffs. For instance,a BMI of 30 indicates a higher diabetes risk in white populations,but for South Asians,that risk level may be reached at a BMI of 23 or 24. She suggested adapting cutoffs by sex, age, race and ethnicity.
Abushamat added that the NLA and Obesity Medicine Association acknowledge that obesity is more than just increased fat; it also involves local and systemic insulin resistance and lipid abnormalities.
She suggested considering waist circumference, waist-to-hip ratio or body composition assessments when evaluating patients, while acknowledging the practical limitations of these methods in routine clinical practice.
Abushamat advocated for shifting from BMI-centric to complication-centric prescribing, focusing on obesity as an adiposity-based chronic disease (ABCD) characterized by dysfunctional adipose tissue, inflammatory mediators and hormonal dysregulation.
She said this approach helps reduce weight stigma and supports more equitable, patient-centered care, focusing on obesity-related complications.
“BMI is not great,and really one of the first steps is acknowledging that obesity is a chronic disease,just like hypertension,diabetes,and hyperlipidemia,” Abushamat said.”We really should be thinking of this from the outlook of managing different stimuli, and also hormones, and that it’s an ABCD. So, we [should] not only focus on the amount of adiposity, but also its function. What hormones are put out by the adipose tissue, what inflammatory markers are present, as well as distribution, so that it’s both a fatty mass disease as well as a sick fat disease.”
patient Selection
While incretin therapies offer benefits, their use requires careful counseling on tolerability and side effects. Gastrointestinal issues like nausea, diarrhea and constipation are common, affecting 40% to 70% of patients, but are usually temporary and manageable with slower dose increases, diet changes, hydration and supportive measures.
GLP-1 receptor agonists are not recommended for patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. Caution is also advised for those with gallbladder disease or pancreatitis.
Abushamat noted that incretin therapies may affect the absorption of oral medications like warfarin, thyroid hormone and oral contraceptives. Patients should adhere to dosing schedules, resume at a lower dose if therapy is interrupted for more than 14 days and hold therapy for 7 days before surgery to reduce anesthesia-related risks.
Access Barriers
Abushamat identified potential barriers to accessing incretin therapies, including supply issues, cost and insurance coverage.
She also noted that patients can have variable responses to incretin therapies and may benefit more from other treatments.
Abushamat cited the high rate of discontinuation of incretin therapies as another crucial consideration.
“Thirty-six point five percent of patients do discontinue these therapies within a year, and when you look at those with obesity, 50% discontinue, and a lot of that has to do with the fact that they get less coverage of these therapies under insurance,” Abushamat said. “We have a long way to go when it comes to cost, coverage, adherence, and also demand and supply, so it’s an active discussion I think that we all need to have as a medical community.”
What’s next
Abushamat said that patient selection should focus on their ability to obtain, tolerate and adhere to incretin therapy. She added that she is excited about the future of these medications and that improvements in access, affordability and reduced stigma toward obesity are needed. She also noted that pharmacogenetics and increasing treatment options may lead to greater benefits for more patients.