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# Semaglutide: 14.5% of US initiators start at high dose, with earlier discontinuation
- URL: https://www.coios.me/semaglutide-14-5-of-us-initiators-start-at-high-dose-with/
- Published: 2026-10-23T13:12:21.000Z
- Updated: 2026-10-23T16:58:21.000Z
- Description: Among US adults starting injectable semaglutide, high-dose initiation was associated with a 25% higher early discontinuation risk and lower 1-year persistence.
- Author: Daniel Ryan
- Tags: Behavioural science, Adherence and persistence, Obesity, diabetes and GLP-1, United States, #peer-reviewed, #refines, #item, #source-2026-10, #score-72

This retrospective cohort study used MarketScan claims from 2018 to 2021 on US adults with diabetes or obesity. All started injectable semaglutide with no prior incretin therapy, and were followed for 12 months. Initiating dose was low (0.5 mg/week or less) or high (1.0 mg/week or more); 14.5% started high. High-dose initiation carried a 25% higher early discontinuation risk (HR 1.25, 95% CI 1.17-1.34). One-year persistence was lower, independent of age, obesity status, co-morbidity and cost; high-dose starts were commoner among men and endocrinologists. Claims data cannot confirm whether dispensed medication was taken, or why treatment stopped.

*Why it is interesting: Persistence on GLP-1 therapy is low in routine care, and this identifies prescriber dosing as a modifiable contributor. It separates initiation behaviour from patient characteristics and cost.*

Source

[Diabetes, Obesity and Metabolism, 19 October 2026](https://doi.org/10.1111/dom.71448?ref=coios.me)

Paper

Real-World Semaglutide Initiation Behaviours in the United States: Impact on Early Treatment Discontinuation and on 1-Year Persistence

Authors

Belalcazar LM, Gao D, Modi S, Meer A, Kuo YF

DOI

10.1111/dom.71448

Type

Peer-reviewed article

Design

Retrospective cohort, MarketScan commercial claims 2018-2021, 48,658 US adults initiating injectable semaglutide; Kaplan-Meier and piecewise Cox models, 12-month follow-up

Verdict

Refines prior evidence

Driver

[Adherence and persistence](https://www.coios.me/d-adherence/)

Driver

[Obesity, diabetes and GLP-1](https://www.coios.me/d-obesity-diabetes/)