Date of Award

January 2025

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Andrew Dewan

Second Advisor

Chenxi Huang

Abstract

Abstract Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are widely prescribed for type 2 diabetes and obesity, with growing interest in their potential effects on mental health and functional outcomes. However, clinical trials often exclude individuals with psychiatric comorbidities, limiting generalizability. Objective: To examine the association between GLP-1 RA use and self-reported mental health and functional outcomes in individuals with diabetes and obesity using real-world data from the All of Us Research Program. Methods: This cross-sectional study analyzed 53,127 adults with type 2 diabetes and 35,430 adults with obesity who had both EHR and survey data. GLP-1 RA users were identified based on prescription data overlapping with the survey period. Ten self-reported outcomes (including general health, fatigue, pain, and social functioning) were assessed. Logistic regression models were used to estimate adjusted odds ratios, stratified by depression and anxiety status. Bonferroni correction was applied for multiple comparisons. Results: GLP-1 RA use was associated with lower odds of reporting favorable outcomes across several domains, particularly in the obesity cohort. In the diabetes group, differences were smaller but remained significant for physical health. Subgroup analyses showed that associations were more consistent in participants without depression or anxiety, while differences in those with psychiatric comorbidities were less pronounced. Conclusion: In contrast to expectations from clinical trials, GLP-1 users reported lower levels of selfperceived well-being in this diverse, real-world population. These findings highlight the importance of understanding how GLP-1 therapy is experienced across psychiatric subgroups and suggest that further research is needed to explore the psychological and functional dimensions of treatment.

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This is an Open Access Thesis.

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