GLP-1RA-Associated Diabetic Lumbosacral Radiculoplexus and Common Fibular Neuropathies: A Case-Control Evaluation.

Area of Science:

• Endocrinology
• Neurology
• Metabolic Diseases

Background:

• Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are widely prescribed for obesity and diabetes management.
• Previous reports suggest GLP-1RA use may be associated with ocular conditions like nonarteritic ischemic optic neuropathy (NAION).
• Diabetic lumbosacral radiculoplexus neuropathy (DLRPN) and common fibular neuropathy (CFN) are known to occur following significant weight loss.

Purpose of the Study:

• To investigate the potential association between the use of GLP-1 receptor agonists (GLP-1RAs) and the development of diabetic lumbosacral radiculoplexus neuropathy (DLRPN) and common fibular neuropathy (CFN).
• To analyze the clinical characteristics and metabolic changes in patients experiencing these neuropathies while on GLP-1RA therapy.

Main Methods:

• A retrospective case-controlled study was conducted using data from April 28, 2005, to December 25, 2024.
• Patients diagnosed with DLRPN or CFN were evaluated for GLP-1RA exposure and clinical details.
• A matched control group was utilized to assess the association between GLP-1RA use and the incidence of these neuropathies.

Main Results:

• The study identified 26 individuals with 27 DLRPN episodes and 77 individuals with 82 CFN episodes, all occurring after GLP-1RA initiation.
• Patients with DLRPN and CFN experienced significant reductions in HbA1c and body mass index (BMI), indicative of substantial weight loss.
• GLP-1RA users showed a significantly higher likelihood of developing DLRPN (OR 1.5) and CFN (OR 1.3) compared to controls, with a notable increase in reported cases post-2015.

Conclusions:

• GLP-1 receptor agonist (GLP-1RA) use is associated with an increased risk of developing diabetic lumbosacral radiculoplexus neuropathy (DLRPN) and common fibular neuropathy (CFN).
• DLRPN appears more strongly linked to metabolic improvements, such as HbA1c reduction, and associated microvasculitis.
• CFN exhibits characteristics of compressive neuropathy and seems more influenced by the degree of weight loss achieved with GLP-1RA therapy.