By Dr. Asnat Raziel, bariatric surgeon specializing in obesity treatment, metabolic health and healthy longevity; Director of the Multidisciplinary Center for Obesity Treatment, Assia Medical, Assuta Ramat HaChayal, Tel Aviv
Foundayo and diabetes prevention: what the new analysis found
Foundayo and diabetes prevention are the subject of a new analysis from the ATTAIN-1 trial. According to the analysis, treatment lowered the predicted risk of type 2 diabetes by up to 57% compared with placebo. In addition, the predicted risk of cardiovascular disease fell by up to 18%. These are encouraging results. However, they rely on prediction models, not on ten years of follow-up of the participants.
Foundayo, whose generic name is orforglipron, is a daily pill from the GLP-1 family. The researchers published the analysis in the journal Diabetes, Obesity and Metabolism. Lilly presented it in an announcement on October 1, 2026. The central question is simple: how might improvements during obesity treatment affect health in the years ahead?
What is Foundayo, and where does it stand today?
Foundayo is a small molecule that activates the GLP-1 receptor. You take it once a day, at any time, with no food or water restrictions. The FDA, the US Food and Drug Administration, approved it in April 2026 for long-term weight management in adults.
Since then, its status has also advanced outside the United States. In Israel, the drug has been available since mid-September 2026. In addition, the scientific committee of the European Medicines Agency recommended on October 16, 2026, approving it for weight management and for type 2 diabetes. To be precise, though, the drug has no specific approval for preventing diabetes or heart disease.
What did researchers examine in the ATTAIN-1 trial?
The ATTAIN-1 trial was a randomized, double-blind, placebo-controlled phase 3 trial. It lasted 72 weeks and included 3,127 people with obesity, or with overweight and a related health condition. None of them had diabetes. The main goal was weight loss. On the high dose, participants lost an average of 11.2% of their body weight, compared with 2.1% on placebo.
In the additional, retrospective analysis, the researchers recalculated each participant’s risk of developing disease over the next ten years. To do this, they used three models. First, the CMDS model, short for Cardiometabolic Disease Staging, to predict diabetes. Second, the Framingham model to predict cardiovascular disease. Finally, the PREVENT model served as an additional check. In other words, the researchers measured changes over about a year and a half, and from those they estimated the ten-year risk forecast.
The data: Foundayo and diabetes prevention at all three doses
According to the company’s announcement, these are the estimated relative risk reductions compared with placebo after 72 weeks:
- 5.5 mg a day: a 45% reduction in predicted diabetes risk, and 13% in predicted cardiovascular risk.
- 9 mg a day: a 50% reduction in diabetes risk, and 15% in heart risk.
- 17.2 mg a day: a 57% reduction in diabetes risk, and 18% in heart risk.
On the high dose, the predicted diabetes risk at the start of the trial was 17.1%. By the end of the trial, it had fallen by 9.8 percentage points. The predicted heart risk was 8.7% and fell by one percentage point. In the placebo group, by contrast, diabetes risk fell by only 1.7 percentage points. Heart risk there actually rose by 0.6 percentage points.
Percentage points vs. relative reduction
It is worth distinguishing between two kinds of numbers. Percentage points describe an absolute change in risk. For example, a drop from 17.1% to about 7.3% is a drop of 9.8 percentage points. On the other hand, the figures of 57% and 18% describe a relative comparison with placebo, based on the model. Therefore, they are not the number of cases actually prevented.
Put simply, at the start of the trial, the model predicted about 17 cases of diabetes over a decade among 100 people in the high-dose group. By the end of the trial, the forecast had dropped to about 7 cases per 100. This is an estimate, not a count of real cases.
Why a risk prediction is not proof of prevention
A prediction model translates data such as weight, blood sugar and blood pressure into a future probability. When those numbers improve, the forecast improves too. This is useful information. Even so, it does not replace a direct count of diabetes diagnoses, heart attacks or strokes over time.
Moreover, the hazard ratios in the analysis also came from the models’ forecasts, based on statistical assumptions. The third model, PREVENT, showed a similar direction, which strengthens the consistency of the finding. However, the analysis does not answer another important question: what happens to risk after treatment stops. You can read about this in my article on stopping weight loss medication.
Side effects and tolerability
The new analysis deals with forecasts, but safety remains part of the picture. In the ATTAIN-1 trial, the main side effects were gastrointestinal: nausea, constipation, diarrhea and vomiting. Most were mild to moderate. In addition, 5.3% to 10.3% of patients on the drug stopped treatment because of side effects, compared with 2.7% on placebo.
That is why it is important to raise the dose gradually and to report any side effect.
Foundayo and diabetes prevention: the open questions
To know how many cases the drug actually prevents, we need trials that count clinical events. Such a trial is already under way. The ATTAIN-Outcomes trial is testing the effect of orforglipron on cardiovascular events in people with overweight or obesity and heart or kidney disease.
Meanwhile, these findings add to what we already know about preventing diabetes. A healthy lifestyle remains the foundation. In addition, long-term studies on prediabetes show how much sticking with healthy habits matters.
What does this mean for patients?
Clinically, these findings broaden the conversation beyond the number of kilograms. Alongside weight, it is worth tracking risk markers as well: fasting blood sugar, HbA1c (the average blood sugar over the past three months), blood pressure and blood fats. Still, we should not conclude from the data that every patient will benefit to the same extent. Nor is the high dose right for everyone.
Choosing a particular pill depends on underlying conditions, tolerability and personal preferences. You will find a comparison of the options in my article on the Wegovy pill vs. Foundayo. For a practical guide to taking the drug, see my article on Foundayo treatment.
Bottom line: Foundayo and diabetes prevention
The message for the public is well-founded hope, but precise hope. Here, Foundayo and diabetes prevention come together in a significant drop in the predicted future risk of diabetes and heart disease. This is an encouraging result regarding the potential of obesity treatment to improve health over time. Ultimately, trials that count clinical events over long follow-up will determine the true extent of prevention.
The information in this article is general and does not replace personal medical advice.
References
Orforglipron, an Oral Small-Molecule GLP-1 Receptor Agonist for Obesity Treatment
Foundayo – European Medicines Agency
Eli Lilly, the drug’s manufacturer, funded the studies.
