Newer diabetes drugs show stronger weight and blood sugar benefits in prediabetes
Last updated May 16, 2026
Key finding
Newer drugs like semaglutide and tirzepatide appear best for weight and blood sugar in prediabetes.
This review compared nine types of diabetes medications in over 16,000 adults with prediabetes across 55 studies. The medications included metformin, newer injectable drugs like semaglutide and tirzepatide, and older pills like pioglitazone. Newer medications like semaglutide and tirzepatide showed the best combined effects for weight loss and blood sugar control. Semaglutide 2.4 mg led to the most weight loss at about 30 pounds. Liraglutide worked best for lowering HbA1c. Older medications like pioglitazone lowered blood sugar effectively but caused weight gain. The newer drugs had more stomach-related side effects but were generally safe.
Quick read
Study at a glance
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EvidenceScore™
Moderate
Study type
Meta-Analysis
Follow-up
Long-Term (> 12 mo)
Risk of bias
Low Risk
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Plain-language summary
What this paper says
A plain-language read of the study’s main message and where it applies.
Study focus
Newer drugs like semaglutide and tirzepatide appear best for weight and blood sugar in prediabetes.
Published in
Journal Reference
Publication details and source links for this paper.
Wu Y, Wang Z, Tuersun A, et al. Efficacy and safety of anti-prediabetic drugs in patients with prediabetes: a Bayesian network meta-analysis. BMC Med. 2026;24:174. doi:10.1186/s12916-026-04705-2
Main Effects
Weight → ↓ (strong with semaglutide, tirzepatide)
HbA1c → ↓ (moderate with most drugs)
Cholesterol → ↓ (moderate with tirzepatide, pioglitazone)
Evidence Suggest
- Newer medications like semaglutide and tirzepatide appear to offer the best combined benefits for weight loss and blood sugar control in people with prediabetes who are overweight
- Older medications like pioglitazone lower blood sugar effectively but cause weight gain, which limits their usefulness
- Effects vary by medication type, with no single drug working best for all outcomes
Who this applies to
Adults aged 18-75 with prediabetes based on blood tests showing HbA1c of 5.7-6.4% or elevated fasting blood sugar
Keep in Mind
Most studies compared drugs to placebo rather than directly to each other, so we can't be certain which drug works best
Between the Lines
- Most studies compared to placebo, not to each other
- Results varied widely between studies
- Study lengths ranged from 3 months to 2+ years
- Most participants were of European ancestry
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