New data on GLP-1 restart patterns: what Canadian patients should know about stopping and restarting weight-loss medications

This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

A retrospective cohort study of more than 60,000 Americans with type 2 diabetes, presented at ENDO 2026 (the Endocrine Society's annual meeting) in July 2026, found that roughly four in ten patients stopped their GLP-1 receptor agonist within the first year of treatment, and nearly six in ten had stopped by the end of year two. More than half of those who stopped restarted within 12 months, and nearly two-thirds did so within two years. For Canadians prescribed semaglutide (sold in Canada as Ozempic for type 2 diabetes and Wegovy for weight management) or tirzepatide (sold in Canada as Mounjaro for type 2 diabetes, with Zepbound not yet approved by Health Canada as of this writing), these numbers matter because provincial drug coverage is patchy and cost is one of the most cited reasons Canadian patients interrupt therapy.

GLP-1 receptor agonists are a class of injectable medications that mimic a gut hormone to lower blood sugar, reduce appetite, and slow gastric emptying. They are prescribed in Canada for type 2 diabetes and, in the case of semaglutide 2.4 mg (Wegovy), for chronic weight management in adults with obesity or overweight plus at least one weight-related condition. The study's lead researcher, Sainikhil Sontha, a research associate at Boston University School of Public Health, described the pattern bluntly: "use is more start-and-stop than most people assumed."

What this means in Canada

Health Canada has approved semaglutide under the Ozempic brand for type 2 diabetes and under the Wegovy brand for weight management. Tirzepatide (Mounjaro) is approved in Canada for type 2 diabetes; a separate weight-management indication has not been approved by Health Canada as of July 2026. Liraglutide (Victoza for diabetes, Saxenda for weight management) is also Health Canada-approved, though the new study found patients on liraglutide were significantly more likely to discontinue than those on newer agents.

Provincial coverage is inconsistent. Ontario's OHIP drug benefit (ODB) covers semaglutide (Ozempic) for type 2 diabetes under specific criteria but does not cover Wegovy for weight management. Quebec's RAMQ covers Ozempic for diabetes but similarly excludes the weight-management indication. British Columbia's PharmaCare and Alberta's AHCIP follow comparable patterns. No provincial formulary in Canada covers Wegovy or Saxenda as a standard benefit for obesity without diabetes as of mid-2026, though some private employer plans do. Patients paying out of pocket for Wegovy face costs in the range of CAD $300 to $500 per month, a figure that maps directly onto the discontinuation risk the ENDO 2026 study identified.

The Society of Obstetricians and Gynaecologists of Canada (SOGC) has not issued a position statement specifically on GLP-1 discontinuation patterns. The Canadian Diabetes Association (Diabetes Canada) recommends GLP-1 receptor agonists as preferred agents for people with type 2 diabetes and established cardiovascular disease or high cardiovascular risk, citing their cardiorenal protective effects, which makes the discontinuation question clinically significant.

What changed

Before this study, clinicians had limited population-level data on how often patients cycle on and off GLP-1 therapy. The ENDO 2026 findings, drawn from Komodo Health US insurance claims from January 2019 to June 2025, fill that gap with a large sample. Discontinuation was defined as a gap of more than 60 days in prescription fills. Reinitiation was defined as a new fill after that gap.

The study found that patients on Medicaid or Medicare (US public insurance programs, roughly analogous to Canadian provincial pharmacare for low-income or elderly populations) were more likely to stop. Black patients and those experiencing nausea or other gastrointestinal side effects (reported by 37% of discontinuers) were also at higher risk of stopping. Patients whose first GLP-1 was prescribed by an endocrinologist were 10% less likely to discontinue, which suggests that specialist involvement in initiating therapy may improve persistence.

The newer agents performed better on persistence. Patients on tirzepatide were 41% less likely to discontinue than those on liraglutide. Semaglutide users were 28% less likely to discontinue than liraglutide users. This is relevant in Canada because liraglutide (Saxenda) remains on the market and is sometimes the only covered option under certain private plans.

"Consistent use of these medications is what produces their protective effects," Sontha said at ENDO 2026. "Stopping early may mean missed opportunities to prevent heart attacks, kidney disease progression and other complications."

What Canadian patients should know

If you have stopped a GLP-1 medication and are considering restarting, the data suggest you are not alone and that restarting is common. Before restarting, it is worth reviewing why you stopped. If the reason was cost, it is worth asking your prescriber whether a different formulation or a patient support program (Novo Nordisk and Eli Lilly both operate Canadian patient assistance programs) could reduce out-of-pocket costs. If the reason was side effects, the study data suggest that newer agents carry lower discontinuation rates, and your prescriber may be able to switch you.

In Canada, GLP-1 prescriptions can be initiated by family physicians, internists, and endocrinologists. Virtual care platforms including Felix (a Canadian telehealth service), Maple, and Telus Health can connect patients with physicians for GLP-1 consultations, though coverage for the medications themselves still depends on your provincial formulary or private plan. Science & Humans (scienceandhumans.com) is a Canadian platform that also offers GLP-1 prescribing. None of these platforms can override provincial formulary decisions.

Patients in provinces without public coverage for weight-management indications may want to ask their physician about applying for special authorization, which some provinces offer for patients with obesity-related comorbidities.

Limitations and open questions

The ENDO 2026 study used US insurance claims data, which does not translate directly to Canada. The US has a fragmented payer system with Medicaid and Medicare as distinct programs; Canada's single-payer provincial structure creates different access barriers. The study cohort was limited to adults aged 18 to 64 with type 2 diabetes and a BMI of 25 or higher, so findings may not apply to patients using GLP-1 medications for weight management without diabetes.

The study has not yet been published in a peer-reviewed journal as of this writing; it was presented as a conference abstract at ENDO 2026. The findings should be treated as preliminary until full peer review is complete.

Health Canada has not issued guidance on GLP-1 restart protocols. The SOGC has not published a position on GLP-1 discontinuation or reinitiation. Canadian-specific data on discontinuation rates, which would account for the provincial coverage landscape, do not yet exist in published form. The Canadian Institutes of Health Research (CIHR) has funded some real-world GLP-1 effectiveness research, but population-level discontinuation data from Canadian claims databases have not been published.

This article is for informational purposes only and is not medical advice. Consult your Canadian healthcare provider about your situation.

Editorial note

Hormone Journal articles are written by our editorial team and reviewed against published clinical guidelines, with a focus on Canadian patient access. We do not promote specific clinics or providers.