GLP-1 RAs tied to higher risks of GERD, complication vs SGLT-2 inhibitors in T2D

Compared with using SGLT-2 inhibitors, treatment with GLP-1 receptor agonists (RAs) may increase the risk for gastroesophageal reflux disease (GERD) and its complications in patients with type 2 diabetes (T2D), a recent study has shown.

A group of researchers conducted an active-comparator new-user cohort study emulating a target trial using the UK Clinical Practice Research Datalink. They identified adults aged 18 years or older with T2D who initiated GLP-1 RAs or SGLT-2 inhibitors between 1 January 2013 and 31 December 2021, with follow-up until 31 March 2022.

Incident GERD was the primary outcome, while its complications were secondary. Propensity-score fine stratification was used to estimate and weigh the risk differences (RDs) and risk ratios (RRs) at 3 years.

Of the participants, 24,708 were new users of GLP-1 RAs and 89,096 were new users of SGLT-2 inhibitors.

GLP-1 RA users were at greater risks of developing GERD (RR, 1.27, 95 percent confidence interval [CI], 1.14–1.42; RD, 0.7 per 100 patients) and its complications (RR, 1.55, 95 percent CI, 1.12–2.29; RD, 0.8 per 1,000 patients) than users of SGLT-2 inhibitors over a median follow-up of 3.0 years.

“Clinicians should be aware of this potential adverse effect to provide timely prevention and treatment strategies,” the researchers said. 

The study was limited by residual confounding due to the lack of information on dietary or lifestyle factors.