In adults with type 2 diabetes, initiation of GLP-1 receptor agonists is associated with no significant difference in medical cost trajectories over two years compared to initiation of SGLT-2 inhibitors or DPP-4 inhibitors, with higher pharmacy costs not accompanied by reduced spending on hospitalizations or provider visits.

GLP-1 receptor agonists increase insulin secretion and reduce glucagon release, lowering blood sugar, but this metabolic change does not reduce the frequency or severity of complications that lead to hospital visits or provider consultations. Higher drug costs are not offset by lower clinical service use because the underlying disease progression and associated complications continue at similar rates regardless of the drug type.