{
  "abstract": "ObjectiveTo determine whether glucagon-like peptide 1 receptor agonist (GLP-1 RA) initiation is associated with excess skeletal muscle loss on repeat whole-body MRI.\n\nResearch Design and MethodsIn the German National Cohort, 58 adults with diabetes who initiated a GLP-1 RA between whole-body MRI examinations 4.6 years apart were matched on sex, age, BMI, and interval to 130 never-exposed controls with diabetes. Deep-learning-segmented tissue volumes were compared within matched sets.\n\nResultsSkeletal muscle volume declined 2.75 percentage points more in initiators (95% CI -4.51 to -0.99; P = 0.003), with 2.54 percentage points greater weight loss (P = 0.021). Adipose tissue differences (-4.8% internal torso, -3.2% subcutaneous) were nonsignificant.\n\nConclusionsIn this first population-based comparison of whole-body MRI before and after GLP-1 RA initiation with matched unexposed controls, initiators lost roughly 60% more muscle. Skeletal muscle loss is a measurable component of GLP-1 RA weight loss in routine care.\n\nArticle HighlightsO_LIWhy did we undertake this study? Rapid uptake of GLP-1 RAs has outpaced evidence on long-term muscle change during routine treatment. C_LIO_LIWhat is the specific question we wanted to answer? We asked whether GLP-1 RA initiation was associated with excess muscle and fat loss versus matched controls with diabetes. C_LIO_LIWhat did we find? Over 4.6 years, initiators lost roughly 60% more skeletal muscle than matched controls (-2.75 percentage points) alongside greater weight loss. Each additional kilogram lost was accompanied by about 100 mL of additional muscle loss. C_LIO_LIWhat are the implications of our findings? Skeletal muscle loss is a measurable component of GLP-1 RA-associated weight loss in routine care. Muscle mass should be monitored during treatment, and muscle-preservation strategies such as resistance training and adequate protein intake need evaluation. C_LI",
  "abstract_shown": true,
  "affiliations": [
    "TUM - Klinikum rechts der Isar"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "E. Stambollxhiu"
    },
    {
      "name": "J. Luebberstedt"
    },
    {
      "name": "M. Kumpf"
    },
    {
      "name": "S. N. Willich"
    },
    {
      "name": "T. Keil"
    },
    {
      "name": "T. Pischon"
    },
    {
      "name": "T. Niendorf"
    },
    {
      "name": "A. Peters"
    },
    {
      "name": "S. Ziegelmayer"
    },
    {
      "name": "M. R. Makowski"
    },
    {
      "name": "K. K. Bressem"
    },
    {
      "name": "L. C. Adams"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/27cqd3pmzg41k.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.15.26363157",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.15.26363157v1.full",
  "id": "27cqd3pmzg41k",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.15.26363157v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "endocrinology"
    ],
    [
      "openalex",
      "2712|Diabetes Treatment and Management"
    ]
  ],
  "openalex": "W7213468607",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.15.26363157v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-15",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/27cqd3pmzg41k.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:47Z",
      "native_id": "10.64898/2026.09.15.26363157",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.15.26363157v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:endocrinology",
      "subfield": "endocrinology-metabolism"
    }
  ],
  "title": "GLP-1 Receptor Agonist Initiation Is Associated With Excess Skeletal Muscle Loss in Adults With Diabetes: A Prospective Population-Based MRI Study",
  "title_text": "GLP-1 Receptor Agonist Initiation Is Associated With Excess Skeletal Muscle Loss in Adults With Diabetes: A Prospective Population-Based MRI Study",
  "type": "preprint",
  "updated_at": "2026-10-30T12:18:47Z",
  "url": "https://research.draconitic.com/paper/27cqd3pmzg41k",
  "venue": "medRxiv",
  "versions": []
}