{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:51:06Z","timestamp":1792813866558,"version":"4.5.0"},"reference-count":27,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2024,2,2]],"date-time":"2024-02-02T00:00:00Z","timestamp":1706832000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"North Dakota State University\u2014RCA Research Support","award":["000365"],"award-info":[{"award-number":["000365"]}],"id":[{"id":"https:\/\/ror.org\/05h1bnb22","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are commonly used diabetes and obesity medications but have been associated with gastrointestinal (GI) adverse events. However, real-world evidence on comparative GI adverse reaction profiles is limited. Objectives: This study aimed to evaluate GI adverse events among GLP-1 RA users and compare semaglutide, dulaglutide, liraglutide, and exenatide safety regarding the GI adverse reaction profile. Methods: This retrospective cross-sectional analysis utilized real-world data on 10,328 adults with diabetes\/obesity in the National Institutes of Health All of Us cohort. New GLP-1 RA users were identified, and GI adverse events were examined. Logistic regression determined factors associated with GI adverse events. Results: The mean age of the study population was 61.4 \u00b1 12.6 years, 65.7% were female, 51.3% were White, and they had a high comorbidity burden. Abdominal pain (57.6%) was the most common GI adverse event, followed by constipation (30.4%), diarrhea (32.7%), nausea and vomiting (23.4%), GI bleeding (15.9%), gastroparesis (5.1%), and pancreatitis (3.4%). Dulaglutide and liraglutide had higher rates of abdominal pain, constipation, diarrhea, and nausea and vomiting than semaglutide and exenatide. Liraglutide and exenatide had the highest pancreatitis (4.0% and 3.8%, respectively). Compared to semaglutide, dulaglutide and liraglutide had higher odds of abdominal pain, and nausea and vomiting. They also had higher odds of gastroparesis than semaglutide. No significant differences existed in GI bleeding or pancreatitis risks between the GLP-1 RAs. Conclusions: In this real-world cohort, GI adverse events were common with GLP-1 RAs. Differences in GI safety profiles existed between agents, with exenatide appearing safer than other GLP-1 RAs, except for gastroparesis. These findings can inform GLP-1 RA selection considering GI risk factors. Further studies are needed to evaluate the causal relationship and GLP-1 RA safety with concomitant medication use.<\/jats:p>","DOI":"10.3390\/ph17020199","type":"journal-article","created":{"date-parts":[[2024,2,2]],"date-time":"2024-02-02T09:24:08Z","timestamp":1706865848000},"page":"199","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":79,"title":["Glucagon-like Peptide-1 Receptor Agonists Associated Gastrointestinal Adverse Events: A Cross-Sectional Analysis of the National Institutes of Health All of Us Cohort"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3967-9658","authenticated-orcid":false,"given":"Wafa Ali","family":"Aldhaleei","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL 32224, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tadesse M.","family":"Abegaz","sequence":"additional","affiliation":[{"name":"Economic, Social and Administrative Pharmacy (ESAP), College of Pharmacy and Pharmaceutical Sciences, Institute of Public Heath, Florida A&M University, Tallahassee, FL 32307, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0581-7808","authenticated-orcid":false,"given":"Akshaya Srikanth","family":"Bhagavathula","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Health and Human Services, North Dakota State University, Fargo, ND 58108, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,2,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"101102","DOI":"10.1016\/j.molmet.2020.101102","article-title":"GLP-1 receptor agonists in the treatment of type 2 diabetes\u2013state-of-the-art","volume":"46","author":"Nauck","year":"2021","journal-title":"Mol. Metab."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"728","DOI":"10.1038\/nrendo.2012.140","article-title":"GLP-1 receptor agonists for individualized treatment of type 2 diabetes mellitus","volume":"8","author":"Meier","year":"2012","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2821","DOI":"10.1007\/s12325-021-01710-0","article-title":"Weight Loss and Maintenance Related to the Mechanism of Action of Glucagon-Like Peptide 1 Receptor Agonists","volume":"38","author":"Ard","year":"2021","journal-title":"Adv. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1085799","DOI":"10.3389\/fendo.2023.1085799","article-title":"GLP-1 receptor agonists for the treatment of obesity: Role as a promising approach","volume":"14","author":"Wang","year":"2023","journal-title":"Front. Endocrinol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e029282","DOI":"10.1161\/JAHA.122.029282","article-title":"Role of Glucagon-Like Peptide-1 Receptor Agonists in Achieving Weight Loss and Improving Cardiovascular Outcomes in People with Overweight and Obesity","volume":"12","author":"Michos","year":"2023","journal-title":"J. Am. Heart Assoc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2452","DOI":"10.1007\/s12325-022-02153-x","article-title":"Efficacy of GLP-1 RA Approved for Weight Management in Patients with or Without Diabetes: A Narrative Review","volume":"39","author":"Jensterle","year":"2022","journal-title":"Adv. Ther."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Popoviciu, M.S., P\u0103duraru, L., Yahya, G., Metwally, K., and Cavalu, S. (2023). Emerging Role of GLP-1 Agonists in Obesity: A Comprehensive Review of Randomised Controlled Trials. Int. J. Mol. Sci., 24.","DOI":"10.3390\/ijms241310449"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1007\/s11883-022-01041-7","article-title":"Glucagon-Like Peptide 1 Receptor Agonists: A Medication for Obesity Management","volume":"24","author":"Taha","year":"2022","journal-title":"Curr. Atheroscler. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1038\/s41574-018-0016-2","article-title":"Glucagon-like peptide 1 in health and disease","volume":"14","author":"Andersen","year":"2018","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e120","DOI":"10.1093\/cvr\/cvab249","article-title":"Glucagon-like peptide-1 receptor agonists: The key to healthy weight loss maintenance?","volume":"117","author":"Lehmann","year":"2021","journal-title":"Cardiovasc. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1043789","DOI":"10.3389\/fendo.2022.1043789","article-title":"Association between different GLP-1 receptor agonists and gastrointestinal adverse reactions: A real-world disproportionality study based on FDA adverse event reporting system database","volume":"13","author":"Liu","year":"2022","journal-title":"Front. Endocrinol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"155","DOI":"10.2147\/DMSO.S348025","article-title":"Difference in Gastrointestinal Risk Associated with Use of GLP-1 Receptor Agonists: A Real-World Pharmacovigilance Study","volume":"15","author":"Zhou","year":"2022","journal-title":"Diabetes Metab. Syndr. Obes."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"102427","DOI":"10.1016\/j.dsx.2022.102427","article-title":"Adverse drug reactions of GLP-1 agonists: A systematic review of case reports","volume":"16","author":"Shetty","year":"2022","journal-title":"Diabetes Metab. Syndr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1001\/jama.2023.19574","article-title":"Risk of gastrointestinal adverse events associated with glucagon-like peptide-1 receptor agonists for weight loss","volume":"330","author":"Sodhi","year":"2023","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1900\/RDS.2014.11.202","article-title":"Adverse effects of GLP-1 receptor agonists","volume":"11","author":"Filippatos","year":"2014","journal-title":"Rev. Diabet. Stud."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1111\/dom.12872","article-title":"Upper and\/or lower gastrointestinal adverse events with glucagon-like peptide-1 receptor agonists: Incidence and consequences","volume":"19","author":"Horowitz","year":"2017","journal-title":"Diabetes Obes. Metab."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1244432","DOI":"10.3389\/fendo.2023.1244432","article-title":"Comparison of the efficacy and safety of 10 glucagon-like peptide-1 receptor agonists as add-on to metformin in patients with type 2 diabetes: A systematic review","volume":"14","author":"Xie","year":"2023","journal-title":"Front. Endocrinol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/dom.14551","article-title":"Gastrointestinal tolerability of once-weekly semaglutide 2.4 mg in adults with overweight or obesity, and the relationship between gastrointestinal adverse events and weight loss","volume":"24","author":"Wharton","year":"2022","journal-title":"Diabetes Obes. Metab."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2210","DOI":"10.1111\/dom.13353","article-title":"Semaglutide induces weight loss in subjects with type 2 diabetes regardless of baseline BMI or gastrointestinal adverse events in the SUSTAIN 1 to 5 trials","volume":"20","author":"Atkin","year":"2018","journal-title":"Diabetes Obes Metab."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Qin, W., Yang, J., Deng, C., Ruan, Q., and Duan, K. (2023). Efficacy and safety of semaglutide 2.4\u2009mg for weight loss in overweight or obese adults without diabetes: An updated systematic review and meta-analysis including the 2-year STEP 5 trial. Diabetes Obes. Metab., 15.","DOI":"10.1111\/dom.15386"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"996179","DOI":"10.3389\/fpubh.2022.996179","article-title":"Gastrointestinal adverse events associated with semaglutide: A pharmacovigilance study based on FDA adverse event reporting system","volume":"10","author":"Shu","year":"2022","journal-title":"Front Public Health"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"All of Us Research Program Investigators (2019). The \u201cAll of Us\u201d research program. N. Engl. J. Med., 381, 668\u2013676.","DOI":"10.1056\/NEJMsr1809937"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Mapes, B.M., Foster, C.S., Kusnoor, S.V., Epelbaum, M.I., AuYoung, M., Jenkins, G., Lopez-Class, M., Richardson-Heron, D., Elmi, A., and Surkan, K. (2020). Diversity and inclusion for the All of Us research program: A scoping review. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0234962"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1001\/jamacardio.2023.2411","article-title":"Representation of race and ethnicity in the contemporary US health cohort all of US research program","volume":"8","author":"Kathiresan","year":"2023","journal-title":"JAMA Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100570","DOI":"10.1016\/j.patter.2022.100570","article-title":"The All of Us Research Program: Data quality, utility, and diversity","volume":"3","author":"Ramirez","year":"2022","journal-title":"Patterns"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2441","DOI":"10.1001\/jama.2021.7702","article-title":"Progress with the All of Us research program: Opening access for researchers","volume":"325","author":"Ramirez","year":"2022","journal-title":"JAMA"},{"key":"ref_27","unstructured":"FDA (2023, December 14). Ozempic (Semaglutide) Injection, Subcutaneous Use. 20 September 2017, Available online: https:\/\/www.accessdata.fda.gov\/drugsatfda_docs\/label\/2017\/209637lbl.pdf."}],"container-title":["Pharmaceuticals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8247\/17\/2\/199\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T13:53:36Z","timestamp":1760104416000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8247\/17\/2\/199"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,2]]},"references-count":27,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2024,2]]}},"alternative-id":["ph17020199"],"URL":"https:\/\/doi.org\/10.3390\/ph17020199","relation":{},"ISSN":["1424-8247"],"issn-type":[{"value":"1424-8247","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,2]]}}}