GLP-1 RA use in T2DM may protect against peptic ulcer disease

Patients with type 2 diabetes mellitus (T2DM) who use glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have lower odds of peptic ulcer disease when compared with insulin users, as shown in a retrospective study.

Researchers used data from the "All of Us" National Institutes of Health database and identified 66,102 participants with T2DM for inclusion in the primary analysis. These participants included those who were newly initiated on GLP-1 RAs or insulin as second-line therapy.

The primary outcome was the odds of peptic ulcer disease diagnosis after time-dependent use of GLP-1 RAs. Factors such as use of insulin, NSAIDs, steroids, and proton pump inhibitors were included in the analyses as potential confounders. A subgroup analysis was conducted, accounting for the competing risks of death and gastrectomy.

GLP-1 RA use was associated with 44-percent lower odds of peptic ulcer disease diagnosis compared with nonuse (adjusted odds ratio, 0.56, 95 percent confidence interval [CI], 0.45–0.71; p<0.001).

In the subgroup analysis of 3,313 patients, including 1,270 new GLP-1 RA users and 2,043 new insulin users, switching to a GLP-1 RA as second-line therapy was associated with a 56-percent lower risk of peptic ulcer disease compared with switching to insulin (adjusted hazard ratio [HR], 0.44, 95 percent CI, 0.30–0.63; p<0.001). A risk increase was also observed among patients who were actively using NSAIDs (HR, 2.39) and steroids (HR, 1.84).