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Cohort Study: Risk of Gallstones and Biliary Complications With Glucagon-Like Peptide-1 Receptor Agonists in Type 2

Mohamed H Eldesouki1, Omar Alkasabrah2, Mohammed Kloub1

  • 1Department of Internal Medicine, New York Medical College at Saint Michael's Medical Center, Newark, New Jersey, USA.

United European Gastroenterology Journal
|June 5, 2026
PubMed
Abstract

Insights

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) may increase the risk of gallbladder disease in type 2 diabetes patients. This includes higher rates of gallstones, cholecystitis, and cholecystectomy, but not pancreatitis.

Area of Science:

  • Endocrinology
  • Gastroenterology
  • Pharmacology

Background:

  • Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are crucial for managing type 2 diabetes mellitus (T2DM).
  • These agents offer benefits in glycemic control, weight reduction, and cardiovascular health.
  • The potential association between GLP-1 RAs and gallbladder disease requires thorough investigation.

Purpose of the Study:

  • To evaluate the risk of gallbladder disease in patients with T2DM treated with GLP-1 RAs.
  • To compare the incidence of various gallbladder-related outcomes between GLP-1 RA users and matched controls.
  • To explore potential differences in risk among specific GLP-1 RA agents.

Main Methods:

  • A retrospective cohort analysis was conducted using the TriNetX research network.
  • Adult patients with T2DM treated with GLP-1 RAs were compared to propensity score-matched controls.
  • Outcomes assessed included cholelithiasis, choledocholithiasis, cholecystitis, pancreatitis, ERCP, and cholecystectomy.

Main Results:

  • GLP-1 RA use was associated with increased rates of cholelithiasis/choledocholithiasis at two and three years.
  • By three years, GLP-1 RA use also showed higher rates of cholecystitis and cholecystectomy.
  • No significant differences in pancreatitis or ERCP rates were observed between groups. Semaglutide and dulaglutide showed higher cholelithiasis risk.

Conclusions:

  • GLP-1 RA use in T2DM patients is linked to a modest increase in gallbladder disease.
  • The study highlights increased risks for gallstones, cholecystitis, and cholecystectomy.
  • Pancreatitis and ERCP rates were not significantly affected by GLP-1 RA treatment.
Keywords:
biliary complicationscholedocholithiasischolelithiasisgallbladder diseaseglucagon‐like peptide‐1 receptor agoniststype 2 diabetes mellitus

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