{
  "abstract": "ImportanceEvidence on GLP-1/GIP therapies is largely derived from trials enrolling selected populations or medical records that miss utilization outside healthcare channels. No nationally representative cohort has characterized real-world uptake, indications, and access.\n\nObjectiveTo characterize GLP-1/GIP prevalence, indication, clinical profile, and access.\n\nDesignProspective cohort study with three GLP-1/GIP surveillance waves (March 2024, December 2024, October 2025).\n\nSettingThe Understanding America Study, an address-based, nationally representative panel of approximately 15,000 US adults aged 18+ years initiated in 2014.\n\nParticipantsUAS participants responding to at least one surveillance wave (n=9150).\n\nExposuresGLP-1/GIP use status (never vs any use, comprising current and former use), self-reported primary indication (diabetes, weight loss, or other), and access pathway (traditional vs non-traditional).\n\nMain Outcomes and MeasuresSurvey-weighted prevalence of GLP-1/GIP use, overall and by indication and access pathway; sociodemographic, cardiometabolic, treatment, and access characteristics; and smartwatch-derived resting heart rate, heart rate variability, maximum activity heart rate, step count, and sleep duration and variability.\n\nResultsAmong n=9150 adults (1274 with any use; 60.9% female; median age 53 years), weighted prevalence increased 46%, from 8.2% (March 2024) to 12.0% (October 2025) representing 32 million. Weight-loss indications grew, reaching nearly half of use (4.1% to 5.6%); diabetes-indicated use was stable (5.3% to 5.4%). Users carried high cardiometabolic burden (obesity, 68.2%; diabetes, 53.6%) but diverged by indication: diabetes-indicated users were older (median, 59 vs 49 years), whereas weight-loss-indicated users were more often female (69.9% vs 51.3%) and healthier. One in three users (~9 million) had non-traditional access, especially in weight-loss-indicated users, of whom 33% had no conventional prescription; 41% used compounding, online, or foreign pharmacies; and, 43% lacked coverage. Non-traditional users were five times as likely to report an unlisted, likely compounded formulation (19.8% vs 4.1%). All p<0.05.\n\nConclusions and RelevanceReal-world GLP-1/GIP use has grown rapidly and diversified substantially in indication, access, and population profile. One in 3 users obtained treatment through nontraditional channels largely invisible to claims data, raising long-term safety, efficacy, and coverage questions. GLIMMER provides a public, nationally representative longitudinal evidence base for future payer and provider decisions.\n\nKEY POINTSO_ST_ABSQuestionC_ST_ABSWho is using glucagon-like peptide-1 receptor agonists or glucose-dependent insulinotropic polypeptides (GLP-1/GIP) therapies in the US, how has use changed since 2024, and how are these medications obtained?\n\nFindingsIn this cohort study of 9150 US adults, GLP-1/GIP use rose significantly from 8.2% to 12.0% (March 2024-October 2025), driven by weight loss; those treated for diabetes were a decade older, lower-income, and in poorer health than those treated for weight loss. Overall, 1 in 3 users obtained treatment outside conventional prescribing and dispensing channels.\n\nMeaningA large and growing share of GLP-1/GIP exposure occurs outside the channels visible to claims-based surveillance.",
  "abstract_shown": true,
  "affiliations": [
    "University of Southern California"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 10,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "R. R. Chaturvedi"
    },
    {
      "name": "T. Gracner"
    },
    {
      "name": "F. Perez-Arce"
    },
    {
      "name": "S.-c. Suen"
    },
    {
      "name": "J. Jin"
    },
    {
      "name": "B. Orriens"
    },
    {
      "name": "R. L. Pacula"
    },
    {
      "name": "A. Sexton Ward"
    },
    {
      "name": "R. Haile"
    },
    {
      "name": "A. Kapteyn"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/0qpm8ncvb8jv1.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.08.28.26361368",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26361368v1.full",
  "id": "0qpm8ncvb8jv1",
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  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26361368v1",
  "language": null,
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "endocrinology"
    ],
    [
      "openalex",
      "2712|Diabetes Treatment and Management"
    ]
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  "openalex": "W7206163965",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26361368v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-08-28",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/0qpm8ncvb8jv1.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:34Z",
      "native_id": "10.64898/2026.08.28.26361368",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.08.28.26361368v1"
    }
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  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:endocrinology",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "GLP-1/GIP Uptake, Indication, and Access Pathways Among US Adults in the Understanding America Study",
  "title_text": "GLP-1/GIP Uptake, Indication, and Access Pathways Among US Adults in the Understanding America Study",
  "type": "preprint",
  "updated_at": "2026-10-30T12:17:34Z",
  "url": "https://research.draconitic.com/paper/0qpm8ncvb8jv1",
  "venue": "medRxiv",
  "versions": []
}