Bowel Obstruction/Ileus Associated With the Use of Glucagon-Like Peptide-1 Receptor Agonists: A Nationwide Database...

The association between glucagon-like peptide-1 receptor agonist (GLP-1RA) use and the development of bowel obstruction/ileus remains unclear, and evidence for specific bowel obstruction/ileus subtypes remains limited. We examined the association between GLP-1RA use and the incidence of bowel obstruction/ileus subtypes across different subgroups of individuals.

Using the commercially available Japanese administrative claims DeSC database, we identified individuals aged ≥ 18 years with type 2 diabetes who newly initiated either GLP-1RAs or sodium-glucose cotransporter 2 inhibitors (SGLT2is) between April 2016 and February 2024. An active-comparator new-user design was adopted, designating GLP-1RA users as the exposure group and SGLT2i users as the control group. The primary outcome was bowel obstruction/ileus requiring tube decompression or surgery within 1 year. Secondary outcomes included specified small bowel obstruction, small bowel obstruction requiring surgery, paralytic ileus and colonic volvulus. Inverse probability weighting with propensity scores was used to adjust for confounding. Adjusted cumulative incidence was estimated using Kaplan-Meier methods; hazard ratios were estimated using Cox regression.

Among 298 124 eligible individuals, 25 779 and 272 345 were classified into the GLP-1RA and SGLT2i groups, respectively. The adjusted 1-year incidence proportion of the primary outcome did not significantly differ between groups (0.14% vs. 0.17%; difference -0.03%, 95% confidence interval (CI), -0.10% to 0.04%; hazard ratio 0.80, 95% CI, 0.52-1.24). No significant between-group differences were observed for the secondary outcomes.

GLP-1RA initiation in individuals with type 2 diabetes was not associated with an increased risk of bowel obstruction/ileus compared with SGLT2i initiation.