Reducing alcohol intake alongside GLP-1 therapy may significantly improve outcomes for patients with obesity or diabetes risk.
In an interview with Pharmacy Times, David Shusterman, MD, chief executive officer at Modern Urologist in New York City, discussed the metabolic, renal, and systemic implications of alcohol consumption and the clinical benefits of glucagon-like peptide-1 (GLP-1) receptor agonists, particularly in the context of weight management and diabetes risk reduction. Shusterman, an early adopter of GLP-1 therapies such as semaglutide (Wegovy; Novo Nordisk) and tirzepatide (Zepbound; Eli Lilly and Company), emphasized that alcohol metabolism places significant stress on the liver, which prioritizes detoxification over glucose regulation. As a result, glycogen synthesis is halted, leading to acute glucose elevations and compensatory insulin release.
“GLP-1 medications actually protect the kidneys by reducing inflammation, improving blood flow, and lowering proteinuria by about 20% to 30%, which helps slow chronic kidney disease.” - David Shusterman, MD
According to Shusterman, repeated alcohol-induced glucose spikes impair insulin sensitivity across multiple organ systems, including skeletal muscle and vascular tissue, ultimately worsening insulin resistance and increasing diabetes risk. Heavy alcohol use has been shown to nearly double blood glucose levels, creating downstream consequences for renal health. Elevated circulating glucose places direct stress on the kidney glomeruli, triggering inflammation, impairing filtration, and accelerating chronic kidney disease progression. These metabolic disruptions also affect blood vessels and peripheral nerves, contributing to the systemic complications commonly seen in poorly controlled diabetes.
GLP-1 receptor agonists counteract these effects through several mechanisms relevant to pharmacists. By mimicking endogenous gut hormones, GLP-1 therapies slow gastric emptying, enhance satiety signaling, and blunt postprandial glucose excursions. This leads to reduced caloric intake, improved glycemic control, and sustained weight loss. Importantly, Shusterman highlighted growing evidence that GLP-1 therapies confer direct renal benefits, including improved renal blood flow, reduced inflammation, and a 20% to 30% reduction in proteinuria, thereby slowing chronic kidney disease progression.
For pharmacists, these findings reinforce the value of counseling patients on alcohol reduction, such as participation in Dry January, when initiating GLP-1 therapy. Limiting alcohol intake can further stabilize insulin response, reduce renal stress, and enhance the overall therapeutic effectiveness of GLP-1 medications in patients with obesity, metabolic syndrome, or central adiposity.
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