GLP-1 THERAPY: HOW CONTINUOUS MONITORING CAN SUPPORT PATIENTS, DOCTORS AND PHARMACEUTICAL COMPANIES

ESTIMATED READING TIME : 5-7 MINUTES | WRITTEN BY DR. ANAND SAINI

Introduction

GLP-1-based therapies have changed the management of type 2 diabetes and obesity. Drugs such as semaglutide and liraglutide (GLP-1 receptor agonists), along with tirzepatide (a dual GIP/GLP-1 receptor agonist), can improve glycaemic control and support substantial weight loss.

Yet one challenge remains: most clinical care still captures patients at isolated points in time.

A patient may be assessed when treatment starts, reviewed during dose escalation, and seen again months later. What happens between those visits is often less visible.

This is where continuous and longitudinal monitoring may add value. Rather than relying only on occasional HbA1c, weight measurements or patient recall, monitoring can help create a clearer picture of how an individual is responding to treatment over time.

FROM SNAPSHOTS TO TRAJECTORIES

HbA1c remains an important measure of glycaemic control, but it does not show the day-to-day pattern behind the average. Similarly, a single clinic weight cannot tell whether a patient is steadily losing weight, has reached a plateau, or has started regaining weight.

Continuous glucose monitoring (CGM), connected weight scales and structured symptom tracking can provide longitudinal information. The objective is not simply to collect more data, but to understand the direction and pattern of change. For patients with type 2 diabetes, particularly those using insulin or therapies associated with hypoglycaemia, CGM can provide clinically useful information during GLP-1 or dual-agonist treatment.

The SURPASS-3 CGM substudy demonstrated that tirzepatide produced better CGM-measured glycaemic control than insulin degludec in adults with type 2 diabetes—though it's worth noting this trial specifically enrolled insulin-naive patients on metformin, with or without an SGLT2 inhibitor, so the findings don't necessarily generalise to patients already on complex insulin regimens.

However, this evidence should not be extrapolated indiscriminately. In people using GLP-1 or dual-agonist therapy for obesity without diabetes, the clinical value of routine CGM remains uncertain.

Continuous monitoring should therefore be guided by clinical need rather than technology alone.

WHAT DOES IT MEAN FOR PATIENTS?

For patients, monitoring can make treatment progress more visible.

A person taking a GLP-1-based therapy may experience changes in appetite, weight, glucose levels and gastrointestinal symptoms over several weeks. Recording these changes can help patients recognise patterns and discuss them more accurately with their healthcare professional.

Weight monitoring can be particularly useful. A gradual decline may reassure a patient that treatment is working, while a sustained plateau can prompt a discussion about adherence, lifestyle factors, treatment response or whether further clinical assessment is needed.

The important point is that monitoring should support—not replace—clinical care. Patients should not independently change their dose based on wearable or home-monitoring data.

WHAT DOES IT MEAN FOR DOCTORS?

For clinicians, longitudinal data can provide visibility between appointments.

Instead of seeing only that a patient's HbA1c has improved, a clinician may be able to understand how glucose patterns changed, whether clinically relevant hypoglycaemia occurred, and how weight responded during treatment.

Similarly, a weight trajectory can provide more context than a single measurement.

This can support more informed conversations around treatment continuation, dose escalation, tolerability and follow-up. In patients taking these therapies alongside insulin, monitoring may be particularly relevant because improving glycaemic control can alter insulin requirements.

In this sense, continuous monitoring does not replace the consultation; it can make the consultation more informative.

WHAT DOES IT MEAN FOR PHARMACEUTICAL COMPANIES?

For pharmaceutical companies, longitudinal data could provide insights that prescription and claims data cannot.

A refill record may show that a patient stopped treatment, but it rarely explains why. Structured monitoring and patient-reported data could help identify relationships between side effects, treatment response, adherence and discontinuation. This may improve patient-support programmes and strengthen real-world evidence.

Long-term monitoring may also become important after treatment discontinuation. In the STEP 1 extension, participants regained approximately two-thirds of their previous weight loss one year after stopping semaglutide, alongside a reversal of several cardiometabolic improvements.

Understanding who regains weight, how quickly it occurs and what factors influence that trajectory could be valuable for long-term treatment planning.

THE OPPORTUNITY—AND THE LIMITATION

Continuous monitoring is not a universal requirement for every person taking a GLP-1-based therapy. Its value depends on the patient, treatment, clinical risk and type of data being collected.

The opportunity is to move from isolated measurements towards a more continuous understanding of treatment response. For patients, that can mean greater awareness; for clinicians, better visibility between visits; and for pharmaceutical companies, richer real-world evidence.

The future of GLP-1 and dual-agonist care may therefore depend not only on which therapy produces the best results in a clinical trial, but also on how well we understand what happens to individual patients between—and beyond—those trial and clinic visits.

REFERENCES

1.     Battelino T, et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care. 2019;42(8):1593–1603.

2.     Battelino T, et al. Efficacy of once-weekly tirzepatide versus once-daily insulin degludec on glycaemic control measured by continuous glucose monitoring in adults with type 2 diabetes (SURPASS-3 CGM). The Lancet Diabetes & Endocrinology. 2022;10(6):407–417.

3.     Wilding JPH, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism. 2022;24(8):1553–1564.

4.     American Diabetes Association Professional Practice Committee. Standards of Care in Diabetes—2025. Diabetes Care. 2025;48(Suppl 1).

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