Association between eating behavior patterns and the therapeutic efficacy of GLP-1 receptor agonists in individuals with type 2 diabetes: A multicenter prospective observational study

Yuya Koide^1,2Takehiro Kato^1*Makoto Hayashi²Hisashi Daido³Takako Maruyama⁴Takuma Ishihara⁵Kayoko Nishimura⁶Shin Tsunekawa⁷Daisuke Yabe^1,7,8*

• ¹Gifu Daigaku Daigakuin Igakukei Kenkyuka Igakubu, Gifu, Japan
• ²Matsunami Sogo Byoin, Hashima District, Japan
• ³Chiho Dokuritsu Gyosei Hojin Gifu-ken Sogo Iryo Center, Gifu, Japan
• ⁴Gifu Shimin Byoin, Gifu, Japan
• ⁵Innovative and Clinical Research Promotion Center, Gifu University Hospital,, Gifu, Japan
• ⁶Division of Clinical Nutrition and Metabolism, Gifu University Hospital,, gifu, Japan
• ⁷Center for One Medicine Innovative Translational Research, Gifu University Institute for Advanced Studies, gifu, Japan
• ⁸Department of Diabetes, Endocrinology and Nutrition,, Kyoto University Graduate School of Medicine, kyoto, Japan

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely used to improve glycemic control and induce weight loss in individuals with type 2 diabetes (T2D), yet treatment responses vary significantly among individuals. Eating behavior has been hypothesized to influence therapeutic efficacy, but supporting evidence remains limited. Methods: In this multicenter, prospective observational study, we enrolled 92 individuals with T2D initiating GLP-1RA therapy (liraglutide, dulaglutide, oral semaglutide, or injectable semaglutide) at four institutions in Gifu Prefecture, Japan. Participants were assessed at baseline, 3 months, and 12 months for clinical parameters, dietary intake, and eating behaviors using validated tools (Food Frequency Questionnaire and the Japanese version of the Dutch Eating Behavior Questionnaire [DEBQ-J]). Primary and secondary outcomes included changes in HbA1c, body weight, and eating behavior patterns over 12 months. Results: GLP-1RA therapy significantly reduced HbA1c, body weight, and body fat percentage at 12 months. Notably, external eating scores showed a sustained decrease, while emotional and restrained eating scores exhibited transient changes. Higher baseline external eating scores were independently associated with greater weight reduction and showed a trend toward enhanced glycemic improvement. No significant associations were observed between emotional or restrained eating scores and clinical outcomes. Conclusion: This study demonstrates that GLP-1RAs improve both metabolic parameters and external eating behavior in T2D individuals. External eating emerged as a potential behavioral marker predictive of treatment response. These findings suggest that integrating eating behavior assessments may help personalize GLP-1RA therapy and optimize outcomes in clinical practice.