Frequency of GLP-1 receptor agonists use in diabetic patients diagnosed with delayed gastric emptying and their demographic profile

Abstract

Advances in the management of diabetes mellitus have come a long way in the 21st century. One of the most important developments in diabetes management has been the discovery of glucagon-like peptide-1 (GLP-1) receptor agonists. The most common side effects of GLP-1 receptor (GLP-1R) agonists are nausea and vomiting which have been attributed to delayed gastric emptying. While the effects of GLP-1R agonists on gastric emptying have prompted further research in this field, there are limited studies evaluating their effects on patients with pre-existing gastroparesis. Additionally, the frequency of GLP-1R agonist use among patients with gastroparesis has not been assessed in the past and this study aims to identify that percentage along with evaluating for possible iatrogenic gastroparesis. A retrospective review of all the gastric emptying studies performed at one academic medical center between January 2019 and January 2021 was performed. We found that although patients on GLP-1R agonists were more likely to have delayed gastric emptying, we could not establish a statistical significance. This could be due to the small sample size in the study. However, GLP-1R agonists use was associated with delayed gastric emptying in patients with diabetes for <10 years. Moreover, a significant proportion (24%) of patients with diabetes with delayed gastric emptying were on a GLP-1R agonist. Recently, semaglutide (GLP-1R agonist) gained Food and Drug Administration approval as a weight loss medication in both patients with and without diabetes. This should prompt further research to evaluate the safety profile of these medications in patients with and without pre-existing gastroparesis.

Tendency of Semaglutide to Induce Gastroparesis: A Case Report

“…A gastric emptying study is considered positive for gastroparesis if there is more than 60% of retaining food after 2 hours or 10% after 4 hours [ 10 ]. Kalas et al reported a study that was conducted on healthy individuals and showed delayed gastric emptying in 50% of healthy participants [ 11 ]. Moreover, the precise prevalence of gastroparesis caused by semaglutide is still unknown.…”

Glucagonlike Peptide-1 Receptor Agonists: The Good, the Bad, and the Ugly—Benefits for Glucose Control and Weight Loss with Side Effects of Delaying Gastric Emptying

“…Further research needs to be done to assess the frequency of misdiagnosing diabetic patients with gastroparesis due to medications, specifically GLP-1 RAs. In a review of gastric emptying scintigraphy (GES) tests performed over 2 y (2019-2021), Kalas et al found that of 384 tests performed, 57% of the patients had diabetes and 24% of the patients with diabetes were on a GLP-1 RA (10). Of the patients with diabetes with delayed gastric emptying, 24% were on a GLP-1 RA.…”

Common postbariatric surgery emergencies for the acute care surgeon: What you need to know

“…74,75 Although these agents are not likely to cause an emergent surgical presentation, they do significantly delay gastric emptying and likely increase aspiration risk perioperatively. 76,77 Increased attention to adequate gastric decompression and aspiration precautions during rapid sequence intubation should be maintained for any patient taking these medications.…”

“…Although previous results with various antiobesity medications have been largely disappointing, much better weight loss and comorbidity control are being seen with newer agents mainly from the glucagon-like peptide-1 agonist family 74,75 . Although these agents are not likely to cause an emergent surgical presentation, they do significantly delay gastric emptying and likely increase aspiration risk perioperatively 76,77 . Increased attention to adequate gastric decompression and aspiration precautions during rapid sequence intubation should be maintained for any patient taking these medications.…”