Among trial participants carrying excess body weight, those assigned the highest dose of orlistat — sold under the brand name Foundayo and taken once daily as an oral tablet developed by Eli Lilly — had a projected 10-year probability of type 2 diabetes onset running 57% below the figure recorded in the placebo arm, according to updated analyses of data from the ATTAIN-1 trial. That figure was generated by a predictive risk model rather than drawn from observed cases of participants who went on to develop the condition. Funding for the trial came from Lilly, which also disseminated the findings.
The ATTAIN-1 trial enrolled 3,127 adults carrying either an obesity diagnosis or excess weight alongside a related health condition. Listed on ClinicalTrials.gov under the identifier NCT05869903, the study was structured as a Phase 3 trial with randomised assignment, double-blind administration, and a placebo-controlled design. At the point of enrolment, a diabetes diagnosis had not been recorded for any of the participants.
At the 72-week mark, participant measurements were fed into a pair of established risk-calculation tools, as outlined in Lilly's announcement. Drawn from indicators including body weight, blood glucose levels, and blood pressure readings, these calculators project how likely an individual is to develop a given condition over time. A decade-long window frames the risk calculations produced by each tool.
Assessing type 2 diabetes risk within that study drew on the Cardiometabolic Disease Staging engine, known as CMDS. Cardiovascular disease assessment relied on a version of the Framingham risk score adapted to body-mass index — a tool that clinicians have drawn on for decades to gauge heart-related risk.
Participants receiving the 17.2 mg dose saw their modelled ten-year diabetes risk drop by 57 percentage points against placebo, while their projected cardiovascular risk came down by 18 percentage points. At reduced dosage levels, the projected outcomes were correspondingly smaller. At the higher 9 mg dose, projected rates of diabetes dropped by around half and cardiovascular risk fell by roughly 15 percent, while the lower 5.5 mg dose pointed toward a 45 percent reduction in diabetes and a 13 percent decrease in cardiovascular outcomes.
In a prepared statement, Thomas Seck — senior vice president of product development at Lilly Cardiometabolic Health — described the ATTAIN-1 follow-up analyses as showing that Foundayo was linked to a reduced projected long-term risk for both conditions, alongside measurable weight loss. Seck also put forward the view that addressing obesity and its downstream effects has the potential to reduce health care costs, though that claim fell outside the scope of what the analysis examined.
Those figures derive from retrospective analyses — work carried out after the trial had concluded, drawing on questions that fell outside the study's original scope. Exploratory analyses run after the fact carry a higher risk of producing results based on random patterns than the primary outcomes a trial was designed to measure from the outset. Published in a peer-reviewed journal, the work has not been replicated by an outside research group.
The 57% projection rests on two conditions: that the health gains observed at the 72-week mark hold steady over time, and that the risk-prediction model translates reliably to people losing weight through medication. As of the time of reporting, neither of those assumptions had been verified.
Spanning only 72 weeks, the study's follow-up period was not long enough to capture how many participants might go on to develop diabetes or heart disease across a full decade. The data pointed to a correlation between Foundayo's effect on certain biological markers and a lower projected disease probability — a finding that falls short of demonstrating the drug prevents illness from taking hold.
In a separate Lilly-sponsored trial pitting Foundayo against insulin among people already living with type 2 diabetes, cardiovascular safety outcomes for the pill proved comparable to those of insulin, though the observed reduction in mortality was drawn from secondary rather than primary analyses. On the question of long-term prevention in people without diabetes, the two studies do not provide a definitive answer.
While the data point toward a potential long-term advantage, no evidence yet establishes that the pill prevents diabetes or heart disease in patients. Households balancing out-of-pocket expenses, coverage gaps, and tolerability can point to documented reductions in body weight, whereas any broader protective effect against disease over time remains at the level of modelling and forecasts.
According to CDC figures, roughly 115.2 million adults across the United States were living with prediabetes in 2023, a total that encompassed 31.3 million people aged 65 and above. Estimates placed roughly 11 million more adults in the category of people carrying undiagnosed diabetes. Households numbering in the tens of millions are affected by how that classification line is drawn. People living with obesity, elevated blood pressure, or a genetic predisposition to diabetes are among those with the greatest stake in what this research reveals.
Adults weighing a GLP-1 tablet as an option often do so against a backdrop of a parent's diabetes diagnosis or their own pre-diabetic blood sugar readings.
Clearance for Foundayo came from the FDA on April 1, 2026, covering adults living with obesity and, under certain conditions, those carrying excess weight alongside related health complications — with the treatment intended to complement dietary changes and physical activity. Regulatory clearance covers both achieving and sustaining a reduction in body weight. No regulatory clearance exists for preventing diabetes or cardiovascular disease, and the findings from this analysis leave that standing unchanged.
Among trial participants who remained on the full highest dose throughout ATTAIN-1, body weight fell by an average of 27.3 pounds — equivalent to 12.4% of starting weight — while those assigned to placebo recorded a drop of just 0.9%.
Three distinct pricing tiers were outlined by Lilly for the drug: those paying out of pocket through LillyDirect would face a floor of $149 per month at the entry-level dose, commercially insured patients who qualify could bring that figure down to $25 per month via a savings card, and a separate $50 monthly cap under Medicare Part D is set to take effect on July 1, 2026. Pricing for individual doses was not published by Lilly, and coverage will differ from one policy to the next. For many households, the price tag places the medication out of reach.
Printed on the medication's label are notices covering a range of potential adverse effects, from thyroid tumours — up to and including malignancy — to pancreatitis, gallbladder and digestive complications, kidney-affecting dehydration, reduced blood sugar levels, and allergic responses. Abdominal pain that is both intense and ongoing, any indication of an allergic response, or a noticeable lump or swelling around the neck area are identified on the label as warranting timely evaluation by a healthcare provider, whereas nausea or loose stools on the milder end are identified as appropriate to raise during a routine consultation with the prescribing clinician.
Those with elevated diabetes risk can discuss blood sugar testing with a healthcare provider, whether through an A1C panel or a fasting glucose measurement. Those already prescribed a GLP-1 medication are advised by the label to keep their current regimen and consult a qualified healthcare provider before making any changes in response to the latest findings.
People considering Foundayo as a treatment option are advised by Lilly to contact their health plan regarding prior authorisation requirements and to compare the savings card, out-of-pocket, and Medicare pathways before filling a prescription. Tracking down definitive conclusions on long-term disease prevention will depend on extended follow-up research that tallies confirmed diagnoses of diabetes alongside documented cardiovascular events.
The projection is drawn from data produced by the manufacturer's own trial, and regulatory approval for Foundayo covers weight reduction specifically — a distinction the label identifies as relevant to discussions with a treating clinician who holds a complete picture of the patient's medical background.
