Impact of glucagon-like peptide-1 receptor agonists on the incidence of inflammatory bowel disease in people with type 2 diabetes

Aims: To evaluate the association between the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and the likelihood of developing inflammatory bowel disease (IBD) and medical utilisation in individuals with type 2 diabetes mellitus (T2DM). Materials and Methods: We used the TriNetX US collaborative network to identify 3 165 521 patients with T2DM from 1 January 2014 to 31 December 2022. Of these, we selected 69 874, 109 922 and 88 079 matched pairs of GLP-1 RA and basal insulin users, dipeptidyl peptidase-4 inhibitor (DPP-4i) and sodium-glucose co-transporter 2 inhibitor (SGLT2i) users, respectively, based on propensity scores. We used the Cox proportional hazards models and subgroup analyses to determine the relative hazards of IBD development and medical utilisation between the study and control groups. Results: In the matched cohorts, GLP-1 RA users had a significantly lower risk of developing IBD (hazard ratio [HR]: 0.725, 95% confidence intervals [CI]: 0.564–0.931) and hospitalisation (HR: 0.144, 95% CI: 0.140–0.148) than basal insulin users. GLP-1 RA users also had a significantly lower risk of developing IBD (HR: 0.814, 95% CI: 0.686–0.966) and hospitalisation (HR: 0.660, 95% CI: 0.647–0.672) than the matched DPP-4i users. GLP-1 RA users had a significantly lower risk of hospitalisation (HR: 0.792, 95% CI: 0.775–0.809) than the matched SGLT2i users. Conclusions: Among patients with T2DM, GLP-1 RA users demonstrated a significantly lower risk of developing IBD than basal insulin and DPP-4i users. GLP-1 RA users also showed a lower risk of hospitalisation. GLP-1 RAs may contribute to lowering the risk of IBD in individuals with T2DM.