1. The use of glucagon-like peptide 1 (GLP-1) receptor agonists in adults with type 2 diabetes mellitus (T2DM) was not associated with increased risks of pulmonary aspiration during upper gastrointestinal endoscopy discontinuation compared to the use of sodium-glucose cotransporter 2 (SGLT-2) inhibitors.

2. The use of GLP-1 receptor agonists among adults with T2DM was associated with greater risks of upper gastrointestinal endoscopy discontinuation compared to the use of SGLT-2 inhibitors.

Evidence Rating Level: 2 (Good)

Recent studies have reported pulmonary aspiration or retained gastric contents with patients using GLP-1 receptor agonists undergoing upper gastrointestinal endoscopy which have led to concerns surrounding their discontinuation prior to elective procedures. However, further evidence is needed to better characterize risks associated with GLP-1 receptor agonists in patients undergoing such procedures. This nationwide cohort study therefore sought to investigate the risk of pulmonary aspiration and endoscopy discontinuation associated with the use of GLP-1 receptor agonist prior to procedure compared to other antidiabetic drugs in patients undergoing upper endoscopy. Adult patients with T2DM who underwent upper endoscopy between January 1st, 2016 and December 31st, 2021 were identified from two nationwide databases (MarketScan Commercial Claims and Encounters, and Optum Clinformatics Data Mart). The primary outcome was pulmonary aspiration on the day of or the day following upper endoscopy, while the secondary outcome was endoscopy discontinuation. 24,824 individuals who underwent upper endoscopy and used a GLP-1 receptor agonist within 30 days prior were identified, and 18,541 individuals who underwent the same procedure and used an SGLT-2 inhibitor within 30 days prior were identified. Compared to individuals using SGLT-2 inhibitor, the use of GLP-1 receptor agonist was not associated with increased risks of pulmonary aspiration (weighted risk 4.15 v 4.26 per 1000 people, respectively; pooled risk ratio 0.98, 95% CI 0.73 to 1.31). However, the use of GLP-1 receptor agonist was associated with increased risks of endoscopy discontinuation compared to the use of SGLT-2 inhibitor (9.79 v 4.91 per 1000 people; pooled risk ratio 1.99, 1.56 to 2.53). Overall, this study found that the use of GLP-1 receptor agonist in patients with T2DM prior to upper endoscopy was not associated with increased risks of pulmonary aspiration compared to the use of SGLT-2 inhibitors, but was associated with increased risks of endoscopy discontinuation. 

Click to read the study in BMJ

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