Who they're for, and who they're not
Not everyone with diabetes is a candidate for a GLP-1, and not everyone who takes one has diabetes. The eligibility picture has gotten muddier as the off-label use for weight loss has exploded, and it's worth being clear about what's actually approved.
GLP-1s are FDA-approved for Type 2 diabetes (all of them) and, for some, separately approved for chronic weight management in people with obesity or overweight with weight-related conditions.
The original approved use is Type 2 diabetes. If your A1C is above target on metformin alone, GLP-1s are now one of the first things many endocrinologists consider next, especially if you also have heart disease, kidney concerns, or excess weight.
For weight management, specific products in the class — semaglutide branded as Wegovy, liraglutide branded as Saxenda, tirzepatide branded as Zepbound — are separately approved for adults with a BMI of 30 or above, or 27 or above with at least one weight-related condition like high blood pressure or sleep apnea.
GLP-1s are not approved for Type 1 diabetes as a primary treatment. They are not currently approved for use in pregnancy. They are not first-line for everyone with Type 2 diabetes — metformin is still the usual starting point, and lifestyle change remains foundational regardless of medication.
Off-label prescribing for weight loss in people who don't meet the BMI thresholds is widespread. That's a separate conversation between you and your doctor. The educational point here is just to know that it's off-label, not standard.
What this means for you
If your doctor brings up a GLP-1, ask whether it's being prescribed for diabetes, for weight management, or both. The answer affects insurance coverage, dosing strategy, and how the medication is monitored.
If you or a family member were considering a GLP-1, which approved use would apply? What questions would you want answered first?