Pulmonary Outcomes in Diabetic Gastroparesis: A Propensity-Matched Study of GLP-1 Agonist Use

Introduction: Gastroparesis is a common complication in patients with diabetes mellitus (DM) and may increase the risk of aspiration and respiratory infections. The use of glucagon-like peptide-1 (GLP-1) receptor agonists, while effective for glycemic and cardiovascular management, has been cautioned in gastroparesis due to its gastric motility effects. However, real-world data on the pulmonary safety of GLP-1 therapy in this population remain limited.


Methods: Using the TriNetX Research Network, we conducted a retrospective, propensity score–matched cohort study including adult patients (≥18 years) with diabetes and gastroparesis. Cohort 1 included patients not exposed to GLP-1 agonists, while Cohort 2 included those with documented GLP-1 use. After 1:1 matching, 15,778 patients remained in each group. Primary outcomes included pneumonitis, pneumonia, ventilator-associated pneumonia, ventilator management procedures, and sepsis. Risk ratios (RR), hazard ratios (HR), and p-values were calculated.


Results: GLP-1 therapy was associated with significantly lower risks of multiple respiratory complications. Compared to non-users, GLP-1 users had reduced incidence of pneumonitis (2.7% vs. 4.9%; RR 1.84; HR 2.17; p< 0.001), pneumonia (13.5% vs. 17.7%; RR 1.32; HR 1.59; p< 0.001), ventilator-associated pneumonia (0.3% vs. 0.4%; RR 1.55; p=0.026), ventilator management (4.1% vs. 7.4%; RR 1.80; HR 2.09; p< 0.001), and sepsis (13.2% vs. 18.9%; RR 1.43; HR 1.74; p< 0.001). No differences were observed in enteral or nasogastric tube placement.


Conclusions: In this large, real-world cohort study, GLP-1 receptor agonist use in patients with diabetes and gastroparesis was not associated with an increased risk of pneumonia-related complications. On the contrary, GLP-1 therapy may confer a protective effect against respiratory infections and sepsis. These findings support the safety of GLP-1 use in appropriately selected patients with diabetic gastroparesis and underscore the need for further prospective research.