Background: Limited recent data exist on prescribing patterns and patient characteristics for glucagon-like peptide 1 receptor agonists (GLP-1 RAs), an important drug class used as anti-diabetic medication (ADM) for patients with type 2 diabetes mellitus (T2D) and/or anti-obesity medication (AOM) in patients with overweight or obesity. For brevity, we use the term GLP-1 RA to refer to both GLP-1 RA and dual GLP-1 RA/GIP medications. Objective: To describe recent trends in prescribing and dispensing of GLP-1-based medications in the US. Methods: Using a subset of real-world electronic health record (EHR) data from Truveta, a growing collective of health systems that provide more than 18% of all daily clinical care in the US, we identified people who were prescribed a GLP-1-based medication between January 01, 2019 and September 30, 2026. We describe prescribing volumes and patient characteristics over time, by medication, and by FDA-labeled use. Among the subset of patients for whom post-prescription dispensing data is available, we describe the proportion and characteristics of patients who were and were not dispensed a GLP-1 RA following their prescription. Results: 4,458,532 patients were prescribed a GLP-1 RA between January 2019 and September 2026, with 23,616,330 total prescriptions during this period. Overall prescribing rates (GLP-1 RA prescriptions as a proportion of all prescriptions) increased by 7.0% from June to September 2026. AOM prescribing increased by 12.2% (+0.38 percentage points), with the largest month-over-month increase occurring from June to July and prescribing remained relatively steady thereafter. On July 1, 2026, the Medicare GLP-1 Bridge Program was implemented to expand access to GLP-1 AOMs for Medicare beneficiaries by reducing out-of-pocket costs. The June-to-July increase coincided with the July 1 implementation of the Medicare GLP-1 Bridge and may reflect expanded access to GLP-1 RAs for weight management through the program. This increase was largely driven by AOM tirzepatide, for which prescribing increased by 16.9%. Although AOM orforglipron prescribing more than doubled (+112.2%), orforglipron still accounted for a small proportion of AOM prescriptions. Tirzepatide remained the most commonly prescribed GLP-1 RA, while semaglutide prescribing remained relatively stable. Among first-time prescriptions for which indication could be established, ADMs accounted for 62.6% and AOMs accounted for 37.4%. Overall, first-time prescribing increased from June to July before declining through August and September, with rates in September similar to June (-1.8%). First-time AOM prescribing also increased from June to July before declining, with rates in September remaining relatively stable compared with June (+3.7%). First-time AOM tirzepatide prescribing increased by 10.1% from June to September, while first-time AOM semaglutide prescribing decreased by 12.5%. Trends in Prescribing: Overall prescribing rates (GLP-1 RA prescriptions per total prescriptions) in September 2026 increased slightly relative to June 2026 (+6.99%). ADM prescribing showed slight month-to-month increases, however ADM prescribing in September 2026 are about the same June 2026 (+2.73%). Month-over-month AOM prescribing increased most from June to July 2026 and remained relatively steady through September 2026. Overall, there was a 0.38 percentage point increase compared with June 2026 (+12.2%). The largest increase came from AOM tirzepatide prescriptions (+16.9%), which accounted for most of the overall increase. AOM orforglipron prescribing more than doubled (+112.2%), although overall prescribing remained low at 0.12% in September 2026. The June-to-July increase in AOM prescribing coincided with the July 1 implementation of the Medicare GLP-1 Bridge and may reflect expanded access to GLP-1 RAs for weight management through the program. Tirzepatide remains the most commonly prescribed GLP-1 RA and continued to increase over the last quarter, particularly when prescribed for obesity, while semaglutide prescribing remained relatively stable. Trends in First-Time Prescribing: Overall first-time GLP-1 RA prescribing increased from June to July 2026, then declined in August and September. By September, first-time prescribing rates were similar to June (-1.81%). First-time prescribing of ADMs decreased in September 2026, relative to June 2026 (-10.85%). First-time AOM prescribing increased from June to July 2026, then declined and remained relatively steady through September. Overall, first-time AOM prescribing in September was similar to June (+3.66%). First-time AOM tirzepatide prescribing increased 10.1%, while AOM orforglipron prescribing nearly doubled (+83.0%), although overall first-time prescribing of AOM orforglipron remained low. Similar to overall prescribing, the June-to-July increase in first-time AOM prescribing coincided with the July 1 implementation of the Medicare GLP-1 Bridge and may reflect expanded access to GLP-1 RAs for weight management through the program. Trends in Dispensing: During the full time period, 69.9% of GLP-1 RA prescriptions had a dispense within 60 days of their prescription (e.g., were initiated within 60 days). For patients first prescribed an ADM in June 2026, 71.5% filled a GLP-1 RA within 60 days. Initiation rates for ADM GLP-1 RA are about the same in June 2026, relative to March 2026 (+0.16%). For patients first prescribed an AOM in June 2026, 44.9% filled a GLP-1 RA within 60 days. Initiation rates for AOM GLP-1 RA are about the same in June 2026, relative to March 2026 (+2.48%). About this report: This report provides recent trends in the prescribing and dispensing of glucagon-like peptide-1 receptor agonist (GLP-1 RAs)-based medications, including dual GLP-1 RA/gastric inhibitory polypeptide (GIP) over time, by medication, and by FDA-labeled use. We used near real-time, aggregated electronic health record (EHR) data from a collective of US...

Hemolytic uremic syndrome (HUS) is a life-threatening complication of Shiga toxin-producing Escherichia coli (STEC) infection. The relationship between STEC exposure and severity of clinical outcomes is not well documented. We examined whether direct contact with farm animals increased the likelihood of HUS among Indiana residents diagnosed with STEC. Exposure data for laboratory-confirmed STEC cases among Indiana residents during 2012–2018 were retrieved. Logistic regression and mediation analysis were performed to determine the extent to which a history of direct contact with farm animals was associated with post-diarrheal HUS independent of age and mediated by stx2 gene presence. A total of 784 STEC cases were retrieved. Of these, 46 (6%) developed HUS. Complete exposure data were available for 600 (77%) cases. A total of 24 (52%) HUS patients reported direct contact with farm animals, while 114 (21%) STEC patients who did not develop HUS reported this exposure. Among all STEC cases, HUS was associated with direct farm animal contact after adjusting for age (OR = 3.40, 95% CI: 1.81, 6.40). Detection of stx2 genes mediated 12% of the association between farm animal contact and HUS. Direct farm animal contact was a risk factor for development of HUS among laboratory-confirmed STEC cases, independent of stx2 presence. Direct farm animal contact should be considered a potential predictor of progression to HUS when patients present for care and the mechanism for its effect on virulence investigated.

Grocery workers were essential to the workforce and exempt from lockdown requirements as per Minnesota Executive Order 20–20. The risk of COVID-19 transmission in grocery settings is not well documented. This study aimed to determine which factors influenced seropositivity among grocery workers. We conducted a cross-sectional study of Minnesota grocery workers aged 18 and older using a convenience sample. Participants were recruited using a flyer disseminated electronically via e-mail, social media, and newspaper advertising. Participants were directed to an electronic survey and were asked to self-collect capillary blood for IgG antibody testing. Data were analyzed using logistic regression and adjusted for urbanicity, which confounded the relationship between number of job responsibilities in a store and seropositivity. Of 861 Minnesota grocery workers surveyed, 706 (82%) were tested as part of this study, of which 56 (7.9%) tested positive for IgG antibodies. Participants aged 65–74 years had the highest percent positivity. Having multiple job responsibilities in a store was significantly associated with seropositivity in our adjusted model (OR: 1.14 95% CI: 1.01–1.27). Workplace factors influenced seropositivity among Minnesota grocery workers. Future research will examine other potential factors (e.g., in-store preventive measures and access to PPE) that may contribute to increased seropositivity.

Shiga toxin-producing Escherichia coli (STEC) transmission occurs in ruminant contact settings and can lead to post-diarrheal hemolytic uremic syndrome (HUS). We investigated whether exposure setting (ruminant exposure from living or working on a farm, visiting a farm or animal contact venue, or both) influenced HUS development among individuals with laboratory-confirmed STEC infections using Minnesota surveillance data from 2010 to 2019. Logistic regression was performed to determine whether exposure setting was associated with HUS independent of age, gender, stx2 gene detection, and county ruminants per capita. Among confirmed STEC cases, ruminant exposure only from living or working on a farm was not significantly associated with HUS compared to cases without any ruminant exposure (OR: 1.25; 95% CI: 0.51, 3.04). However, ruminant exposure only from visiting a farm or public animal contact venue was associated with HUS (OR: 2.53; 95% CI: 1.50, 4.24). Exposure from both settings was also associated with HUS (OR: 3.71; 95% CI: 1.39, 9.90). Exposure to ruminants when visiting farms or animal contact venues is an important predictor of HUS, even among people who live or work on farms with ruminants. All people, regardless of routine ruminant exposure, should take care in settings with ruminants to avoid infection with STEC.