Are GLP-1 Medications Safe for Long-Term Use in Patients with Type 2 Diabetes?
Are GLP-1 Medications Safe for Long-Term Use in Patients with Type 2 Diabetes?
— By Dawn M. Sweet, Ph.D.
GLP-1 medications are increasingly used for weight loss and glycemic control in adults with obesity and type 2 diabetes, but health care professionals are advised to monitor their safety, especially for long-term use in patients with comorbidities, as well as for cardiovascular outcomes, potential pancreatic cancer risks, and anesthesia-related complications.
GLP-1 mediations have become a seemingly integral part of weight loss programs for adults with obesity and type 2 diabetes. In addition to weight loss, GLP-1s offer glycemic control, cardiovascular, and cardiometabolic benefits.1 As these medications ostensibly have become a permanent presence in the treatment landscape of weight loss and type 2 diabetes, health care professionals are encouraged to monitor GLP-1 safety. Because many patients with type 2 diabetes have commodities, it is particularly important to monitor the safety of GLP-1 medications for long-term use.
GLP-1s and Cardiovascular and Renal Safety
Empirical evidence seems to suggest that GLP-1 medications are safe for patients with type 2 diabetes and Cardiovascular Disease (CVD); however, there are ongoing clinical trials to assess their long-term safety, therefore, health care professionals should remain vigilant and monitor for the latest safety updates.1
Across eight Cardiovascular Outcome Trials (CVOT), GLP-1 medications have been found to reduce the risk of Major Adverse Cardiovascular Events (MACE), including non-fatal myocardial infarction, non-fatal stroke, cardiovascular death, and kidney disease in adults with type 2 diabetes.2 Additionally, GLP-1s have reduced blood pressure, postprandial lipemia, and inflammation, thus further contributing to cardiovascular health.2
In support of the above, a review of another eight CVOTs showed that there was a 12 percent reduction in all-cause mortality and an 11 percent reduction in heart-failure hospitalizations.3 The FLOW trial (n = 3,333) randomized 1,766 adults with type 2 diabetes and Chronic Kidney Disease (CKD) to a semaglutide group (1 mg q.w.) and 1,766 to a placebo group.4 A 24 percent reduction of the primary renal and cardiovascular outcomes was observed in the semaglutide group.
A Study of Tirzepatide Compared with Dulaglutide on Major Cardiovascular Events in Participants With Type 2 Diabetes (SURPASS-CVOT) is an ongoing randomized, double-blind, active-controlled CVOT.5 Participants (n = 13,299) with atherosclerotic CVD and type 2 diabetes were randomized 1:1 to tirzepatide (2.5 mg q.w. with 10 weeks of 2.5 escalation up to 15 mg or maximum tolerated dose q.w.) or dulaglutide (1.5 mg with a sham escalation). During the phase 3 SURPASS, tirzepatide was not associated with an uptick in CV events, though the authors note that the total number of participants with CVD at this phase was too small to offer a clear conclusion relative to potential CV benefits.
GLP-1s and Pancreatic Cancer
There were early concerns about the association between GLP-1 medications and cancer. However, multiple clinical trials and large-scale registry studies have not found an increased risk of acute pancreatitis or pancreatic cancer in GLP-1 users. In a population-based historical cohort study of adults with diabetes,6 the safety of GLP-1 was assessed in 33,377 participants, while the safety of insulin was assessed in 1,076,849 participants. A comparison of one defined daily dose of GLP-1 versus insulin during years five to seven showed a pancreatic cancer hazard ratio of 0.50, with no evidence supporting an increased risk of pancreatic cancer.
GLP-1s and Anesthesia-Related Aspiration
One hallmark of GLP-1 medications is delayed stomach emptying, which poses a risk of aspiration for patients undergoing anesthesia. However, the risk of aspiration during surgery is rarely discussed in adults with type 2 diabetes who use GLP-1 medications.1 In a retrospective analysis of 404 adults with obesity and type 2 diabetes undergoing esophagogastroduodenoscopy (33 semaglutide users and 371 non-users),7 there was a greater proportion of gastric contents in the semaglutide users (6.7 percent) compared to non-users (5.1 percent). Given the risk of aspiration among GLP-1 users, the American Society of Anesthesiologists recommends discontinuing GLP-1 medications at least one week prior to surgery.1
Implications for Clinical Practice
Although GLP-1 medications are generally safe for adults with obesity and type 2 diabetes, the need for monitoring remains. To date, there is no significant, long-term data on the safety of these medications, so health care professionals should continue to monitor their patients with type 2 diabetes who are taking a GLP-1 medication. Because these medications work optimally when paired with lifestyle changes, health care professionals should work with patients to develop sustainable, long-term dietary and physical activity changes.
Further, since GLP-1 medications work best when paired with sustainable lifestyle changes, incorporating meal replacements can be a practical strategy for patients with type 2 diabetes and obesity. These products offer portion-controlled, nutrient-dense options that help manage calorie intake and simplify meal planning, making it easier for patients to stick to dietary guidelines. By replacing high-calorie meals with balanced, low-glycemic options, meal replacements can complement the appetite-suppressing effects of GLP-1 medications and support long-term weight management.
Source(s):
1 Efficacy and safety of GLP-1 medications for type 2 diabetes and obesity
2 Glucagon-like peptide 1 receptor agonists: Cardiovascular benefits and mechanisms of action
4 Effects of semaglutide on chronic kidney disease in patients with type 2 diabetes
About the Author: Dr. Dawn M. Sweet has over 20 years of experience in the field of communication. Dr. Sweet has given several invited talks to and workshops for academic and private sector audiences on the role of nonverbal and verbal communication in achieving positive outcomes and mitigating bias. Her research has been published in several top ranked peer-review journals, and it has been featured on NPR’s River to River / All Things Considered, Buzzfeed, and Science Daily. Her research has also been used to inform expert testimony.
About Robard: Robard Corporation has proudly set the standard for medical weight management since 1976. Our evidence-based weight management programs and science-driven nutritional products are the cornerstone of success for leading hospitals, physicians, and weight management clinics across the United States. To learn more about us and how we can help your practice and patients, visit us online www.Robard.com, email us at info@robard.com, or call (800) 222-9201.
