Hormonal
In patients with type 2 diabetes, initiating GLP-1 receptor agonists (GLP-1RA) is associated with a significantly higher risk of gastroparesis compared to initiating SGLT2 inhibitors or insulin glargine, while insulin glargine is associated with a higher risk of all-cause mortality compared to GLP-1RA.
If you have type 2 diabetes and are considering a GLP-1RA (like semaglutide or dulaglutide), be aware that these drugs can slow down your stomach emptying, increasing the risk of gastroparesis. This risk is higher with GLP-1RA than with SGLT2 inhibitors (like empagliflozin) or insulin glargine. However, GLP-1RA is associated with a lower risk of death compared to insulin. If you are already at risk for gastroparesis, talk to your doctor about SGLT2 inhibitors as a first-line alternative to GLP-1RA.
Compared to SGLT2i, GLP-1RA had a higher hazard of gastroparesis (HR 1.65, 95% CI 1.33–2.05)... Compared to insulin glargine, GLP-1RA had a higher hazard of gastroparesis (HR 1.24, 95% CI 1.02, 1.52), but a lower hazard of all-cause death (HR 0.62, 95% CI 0.58, 0.66).
Why this rating
Large-scale active comparator, new user design with inverse probability weighting in a national cohort (N=141,080).
Source
Glycemic therapies and the risk of gastrointestinal adverse events in veterans with type 2 diabetes
Amara Sarwal et al. · Diabetes Obesity and Metabolism · 2025
DOI 10.1111/dom.16642
Related findings · Hormonal
- Initial treatment for type 2 diabetes should be a combination of metformin and either an SGLT-2 inhibitor or a GLP-1 receptor agonist to achieve cardiorenal protection, rather than monotherapy or older agents like sulfonylureas.Strong
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