Prediabetes is a recognized risk state for progression to T2D. GLP-1 RA therapy in prediabetes is supported by mechanism and weight-loss benefit but is off-label for prediabetes specifically — most prescribing happens through the obesity indication.
The evidence
No GLP-1 RA has a prediabetes-specific FDA indication. STEP-1 (semaglutide weight, no diabetes) included patients across the prediabetic A1c range. SURMOUNT-1 (tirzepatide weight, no diabetes) included similar populations. Weight loss in these trials reduces progression to T2D substantially.
FDA-approved labeling status
Off-label for prediabetes specifically. Typically used through the obesity indication if BMI eligibility is met (BMI ≥27 with prediabetes as the comorbidity).
Practical considerations
Lifestyle intervention (diet, exercise, modest weight loss) remains first-line for prediabetes per ADA. GLP-1 RA is reasonable when lifestyle alone is insufficient and BMI eligibility for obesity indication is met.