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Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
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Dipeptidyl peptidase 4 (DPP-4) is a serine protease widely distributed in the body. It's involved in the inactivation of GLP-1 and GIP hormones, which are crucial for insulin regulation. DPP-4 inhibitors, such as sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina), and vildagliptin (Galvus), help increase the proportion of active GLP-1, enhancing insulin secretion. These inhibitors work by competitively binding to DPP-4. This binding causes a...
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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
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Postoperative Aspiration Pneumonia Among Adults Using GLP-1 Receptor Agonists.

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Preoperative use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) did not increase the risk of postoperative aspiration pneumonia in common surgeries. This finding may impact guidelines on withholding GLP-1 RAs before procedures.

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Area of Science:

  • Anesthesiology
  • Pharmacology
  • Gastroenterology

Background:

  • Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly used for weight management.
  • Concerns exist regarding potential surgical complications associated with preoperative GLP-1 RA use.
  • Limited data are available on the association between preoperative GLP-1 RA use and postoperative outcomes.

Purpose of the Study:

  • To determine if preoperative GLP-1 RA use is linked to a higher risk of aspiration pneumonia after common surgical procedures.
  • To investigate the safety of continuing GLP-1 RAs prior to elective surgeries.

Main Methods:

  • Retrospective cohort study using MarketScan commercial claims databases (April 2020 - September 2022).
  • Included patients undergoing 1 of 14 common surgical procedures, excluding those with specific comorbidities or prior respiratory issues.
  • Analyzed 366,476 patients, comparing outcomes between GLP-1 RA users and nonusers, with adjustment for covariates.

Main Results:

  • 1.6% of patients (5,931) had a preoperative GLP-1 RA prescription.
  • GLP-1 RA users were more likely to be female and have obesity and diabetes.
  • No significant difference in the odds of 30-day postoperative aspiration pneumonia was observed between GLP-1 RA users and nonusers (OR, 0.78; 95% CI, 0.57-1.06).

Conclusions:

  • Preoperative GLP-1 RA use is not significantly associated with an increased risk of short-term postoperative aspiration pneumonia.
  • Current findings suggest that preoperative withholding guidelines for GLP-1 RAs may warrant reevaluation.
  • This study contributes to understanding the perioperative safety of GLP-1 RAs.