GLP-1 Receptor Agonists Linked to Reduced Unhealthy Alcohol Use Among Veterans With Type 2 Diabetes
Key Clinical Summary
- Veterans with type 2 diabetes using GLP-1 receptor agonists reported lower rates of unhealthy alcohol use.
- The association was stronger among patients with obesity compared to those without obesity.
- Findings suggest potential neurobehavioral benefits of GLP-1RAs beyond glycemic and weight control.
At ObesityWeek 2025, researchers presented a Veterans Health Administration (VHA) analysis exploring the relationship between unhealthy alcohol use and glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy in patients with type 2 diabetes. The study found a significant association between GLP-1RA receipt and lower alcohol consumption scores, particularly among patients with obesity.
Study Findings
Using data from the VHA Corporate Data Warehouse (fiscal years 2017-2023), researchers analyzed 2 142 992 veterans diagnosed with type 2 diabetes. The cohort’s mean age was 68 years, with 95% male and 5% female participants. Racial and ethnic composition included 65% White, 19% Black, 7% Hispanic, and 9% Other.
Twelve percent of the cohort had received at least one GLP-1RA prescription (exenatide, dulaglutide, liraglutide, semaglutide, or tirzepatide). Unhealthy alcohol use was measured by the Alcohol Use Disorders Identification Test (AUDIT-C), a validated screening tool routinely administered in the VHA system.
Two negative binomial regression models, stratified by obesity status, assessed the relationship between GLP-1RA use and AUDIT-C scores. After adjusting for demographic, clinical, and behavioral confounders, GLP-1RA use was significantly associated with lower levels of unhealthy alcohol consumption. Among patients with obesity, the prevalence ratio for unhealthy alcohol use was 0.78 (95% CI; 0.77-0.78), compared with 0.81 (95% CI; 0.80-0.82) in those without obesity.
The study concludes that GLP-1RA use correlates with lower alcohol consumption, and the effect is more pronounced in individuals with obesity, suggesting a shared neurobiological mechanism underlying food and alcohol cravings.
Clinical Implications
For managed care and payer stakeholders, these findings highlight a potential secondary benefit of GLP-1RAs in populations with type 2 diabetes and coexisting alcohol-related risk. As GLP-1RAs gain traction for weight management and metabolic disease, their potential to influence alcohol use behaviors could have implications for integrated behavioral and chronic disease management strategies.
This association may guide formulary decisions, particularly in veterans or high-risk populations where comorbid obesity, diabetes, and substance use overlap. However, given the cross-sectional design, causality cannot be established. Further longitudinal research is needed to assess whether GLP-1RAs directly reduce alcohol use or whether prescribing patterns reflect patient characteristics and clinician judgment.
“The negative association between GLP-1RA use and unhealthy alcohol use was stronger in patients with obesity compared to patients without obesity,” investigators reported. They cautioned that unmeasured confounding factors—such as patient motivation, physician prescribing habits, and limited female representation—may have influenced results.
Conclusion
This large-scale VHA analysis underscores an emerging behavioral benefit of GLP-1RAs among patients with type 2 diabetes. The findings warrant prospective studies to clarify the temporal and mechanistic relationship between GLP-1RA therapy and alcohol consumption behaviors in populations with and without obesity.
Reference
Patel AV, Chen AS, Gordon KS, et al. Association between unhealthy alcohol use and GLP-1RA receipt in patients with and without obesity. Presented at The Obesity Society’s ObesityWeek; November 4-7, 2025. Atlanta, Georgia.
