TrialTracker_MD said:

ClinicalTrials.gov GLP-1 trial tracker — updated weekly Posting this as an important update for the clinical trials & research community.

Agreed, and subgroup analyses deserve particular suspicion. With enough subgroups something is significant by chance, and pre-registered subgroups are a different animal from ones found afterwards.

I would rather be corrected than agreed with, if it comes to it.

TrialTracker_MD said:

ClinicalTrials.gov GLP-1 trial tracker — updated weekly Posting this as an important update for the clinical trials & research community.

Pushing back on TrialTracker_MD here. I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them. The results probably generalise, and "probably" should be stated as an assumption rather than dropped.

Answering the narrow version, because the broad one does not have a single answer. The gap between trial results and real-world results is consistent and it is not fraud. Trial participants get titration by protocol, scheduled contact, free drug and dietetic support; removing that infrastructure costs a few percentage points every time it has been measured. When your own curve sits below the published mean, that is the likeliest explanation before anything about you or your material.

SarahChen_PharmD said:

Agreed, and subgroup analyses deserve particular suspicion.

Can confirm the pattern SarahChen_PharmD describes. Read four things before the headline number. The population, because trial populations are selected and supported in ways that real cohorts are not. The comparator, because "better than placebo" and "better than the current standard" are different claims and get reported identically. The primary endpoint as pre-registered, because a secondary endpoint promoted after the fact is a hypothesis rather than a finding. And the completion rate, because a large effect in the half of participants who finished is a different result from a large effect in everybody enrolled.