GLP-1s: Missing 50% of high-risk patients? · The Monday Briefing, 28 September 2026

September 28, 2026  ·  Weekly Newsletter

The question of who truly benefits from GLP-1 receptor agonists is still vexed, even with their widespread adoption. New data from EASD suggests the current BMI cutoffs for these drugs might be missing a significant portion of high-risk patients, specifically those classified merely as overweight. This week's edition unpacks that discrepancy and its implications for cardiovascular risk management.

1. **GLP-1s and BMI**, GLP-1 receptor agonists are approved for weight loss at a BMI of 30 or above, or 27 and above with a weight-related condition. Patients with a BMI between 25-26.9, classed as overweight, currently have no access to these drugs, regardless of their actual cardiovascular risk. That exclusion is being challenged. 2. **CT Scans for Osteoporosis**, Cranial CT scans, performed for other indications, can predict major osteoporotic fractures using Hounsfield unit measurements. This offers a low-cost, opportunistic screening route for a silent disease. 3. **Gut Microbiome and T2D**, A study of over 200,000 individuals identified 789 gut bacterial species linked to type 2 diabetes. This same microbial signature is detectable in people before their blood sugar levels rise, suggesting an early biomarker.

This week's evidence points to a growing recognition that traditional diagnostic and eligibility criteria, often based on single markers like BMI or blood glucose, are becoming insufficient. We are seeing a shift towards a more holistic, risk-based approach, leveraging existing data or novel biomarkers to identify patients earlier and more accurately. The established lines are blurring.

Clinicians should scrutinise current eligibility criteria for high-impact drugs, remembering that risk often extends beyond simple cutoffs.

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Coronary Artery Disease

GLP-1 receptor agonists are approved for weight loss at a BMI of 30 or above, or 27 and above with a weight-related condition. Below that, at a BMI of 25-26.9, someone is classed as overweight but currently has no route to the drugs, regardless of their actual cardiovascular risk. New data presented at the EASD Annual Meeting in Milan tests whether that cutoff is drawn in the right place.

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