Cosmos Study

Non-Diabetic Patients on GLP-1 Medications Have an Increased Likelihood of GI Side Effects Compared to Patients on Other Weight Loss Medications

May 2, 2024

Team A:Kersten Bartelt, RNJoe Deckert, PhD

Team B:Steve Allen, MDBrendan Joyce

Key Findings

Non-diabetic patients prescribed liraglutide have an increased likelihood of experiencing delayed gastric emptying and ileus compared to those on a weight loss medication not classified as a glucagon-like peptide-1 receptor agonist (GLP-1).
Non-diabetic patients prescribed semaglutide have an increased likelihood of delayed gastric emptying and gallstones compared to those on other weight loss medications.

We recently noted that diabetic patients prescribed a glucagon-like peptide-1 receptor agonist (GLP-1) medication have an increased likelihood of delayed gastric emptying, also known as gastroparesis, and a reduced likelihood of gallstones and ileus compared to diabetic patients not on a GLP-1.¹ To understand whether non-diabetic patients prescribed GLP-1 medications experience similar rates of these gastrointestinal (GI) side effects, we studied 367,439 non-diabetic patients, including 170,842 who were on a GLP-1 medication and 196,597 who were on other weight loss medications.

We adjusted for factors including patient sex, social vulnerability, BMI classification, race, ethnicity, and age. We limited our analysis for this study to liraglutide and semaglutide medications as they are FDA-approved for weight loss, while other GLP-1 medications are not. Tirzepatide, while FDA-approved for weight loss, was not included because the recency of that approval limited the data available for analysis.²

For non-diabetic patients prescribed liraglutide, we observed an increased likelihood of delayed gastric emptying (139%) and ileus (32%), but no difference in likelihood of gallstones when compared to those on a non-GLP-1 weight loss medication. For patients prescribed semaglutide, the likelihood of delayed gastric emptying and gallstones increased 39%, but we found no statistically significant change in the likelihood of ileus.

Figure 1

GI Side Effect Likelihood by GLP-1 Medication Among Non-Diabetic Patients

Figure 1. The likelihood of GI side effects for non-diabetic patients prescribed GLP-1 medications.

These data come from Cosmos, a dataset created in collaboration with a community of Epic health systems representing more than 246 million patient records from 1,400 hospitals and more than 32,800 clinics from all 50 states and Lebanon. This study was completed by two teams that worked independently, each composed of a clinician and research scientists. The two teams came to similar conclusions. Graphics by Brian Olson.

References

Bartelt K, Deckert J, Allen S, Joyce B. Delayed Gastric Emptying More Likely, Gallstones and Ileus Less Likely for Diabetic Patients on GLP-1 Medications Compared to Diabetics on Other Treatments. Epic Research. https://epicresearch.org/articles/delayed-gastric-emptying-more-likely-gallstones-and-ileus-less-likely-for-diabetic-patients-on-glp-1-medications-compared-to-diabetics-on-other-treatments. Accessed on May 1, 2024.
FDA Approves New Medication for Chronic Weight Management. U.S. Food and Drug Administration. Published November 8, 2023. https://www.fda.gov/news-events/press-announcements/fda-approves-new-medication-chronic-weight-management. Accessed March 7, 2024.