My own decision is to start a GLP-1 and I already have my primary care provider blessing on this. But let me be clear, I am not choosing to start the GLP-1 to slow MGUS progression. If I get that benefit, that’s an added benefit. It has more to do with my prediabetes number (A1C 6 from 5.8), struggling with weight 6’5”/260lbs, a big belly, and the neuropathy. Without those issues I would not start a GLP-1 to slow the progression of MGUS at my level,0.99 g/dl, IGg. It’s intriguing information but I prefer evidence based medicine with well done, randomized control trials. If the metformin study is positive, you can bet the GLP-1 companies will start their own trials. Another population study compared GLP-1 to metformin and insulin in type 2 diabetics. The GLP-1 was superior to insulin in reducing all hematologic cancers, and better than metformin in reducing myelodysplastic syndromes and myeloproliferative neoplasms. GLP-1 showed no difference in MGUS progression compared with metformin. BUT the GLP-1 and metformin may have anti proliferation benefits outside of glycemic control.
“ Hematologic cancers among patients with type 2 diabetes prescribed GLP-1receptor agonist” JAMA network
Again, I would not be starting a GLP-l or metformin solely on my level of MGUS, 0.99IGg. If I was high risk MGUS or SMM, I would be eagerly waiting the metformin data and have my provider treating my MGUS/SMM aware of it and the GLP-1 data. As a sidenote, if you’re on a GLP-1 or metformin, watch your B12 levels particularly if you have neuropathy.
Best wishes everyone!