Glucagon-like peptide-1 receptor agonists before upper gastrointestinal endoscopy and risk of pulmonary aspiration or discontinuation of procedure: cohort study

BMJ, Год журнала: 2024, Номер unknown, С. e080340 - e080340

Опубликована: Окт. 22, 2024

Abstract Objective To assess whether use of glucagon-like peptide-1 (GLP-1) receptor agonists before upper gastrointestinal endoscopy is associated with increased risk pulmonary aspiration or discontinuation the procedure compared sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Design Cohort study. Setting Two deidentified US commercial healthcare databases. Participants 43 365 adults (≥18 years) type 2 diabetes who used a GLP-1 agonist SGLT-2 inhibitor within 30 days endoscopy. Main outcome measures The primary was on day after endoscopy, defined using diagnostic codes. secondary Risk ratios and corresponding 95% confidence intervals (CIs) were estimated fine stratification weighting based propensity score. Results After weighting, 24 817 (mean age 59.9 years; 63.6% female) 18 537 an (59.8 63.7% female). Among users inhibitors, weighted per 1000 people was, respectively, 4.15 4.26 for 9.79 4.91 Compared use, not (pooled ratio 0.98, CI 0.73 to 1.31), although it higher (1.99, 1.56 2.53). Conclusions In this comparative cohort study, no during observed among inhibitors procedure; however, possibly owing retained gastric content. absence evidence from randomized trials, these findings could inform future practice recommendations preprocedural protocol patients requiring

Язык: Английский

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Elective peri‐operative management of adults taking glucagon‐like peptide‐1 receptor agonists, glucose‐dependent insulinotropic peptide agonists and sodium‐glucose cotransporter‐2 inhibitors: a multidisciplinary consensus statement

Anaesthesia, Год журнала: 2025, Номер unknown

Опубликована: Янв. 9, 2025

Summary Introduction Glucagon‐like peptide‐1 receptor agonists, dual glucose‐dependent insulinotropic peptide agonists and sodium‐glucose cotransporter‐2 inhibitors are used increasingly in patients receiving peri‐operative care. These drugs may be associated with risks of pulmonary aspiration or euglycaemic ketoacidosis. We produced a consensus statement for the management adults taking these drugs. Methods This multidisciplinary included surgeons, anaesthetists, physicians, pharmacists people lived experience relevant to guidelines. Following directed literature review, three‐round modified Delphi process was conducted generate ratify recommendations. Results Patients glucagon‐like should: continue before surgery; have full risk assessment stratification; receive techniques that mitigate before, during after sedation general anaesthesia. should omit them day procedure. All mitigation strategies discussed shared decision‐making approach. Discussion Until more evidence becomes available, this pragmatic, aims support improve safety period.

Язык: Английский

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Efficacy of GLP-1 Receptor Agonists on Weight Loss, BMI, and Waist Circumference for Patients With Obesity or Overweight: A Systematic Review, Meta-analysis, and Meta-regression of 47 Randomized Controlled Trials

Diabetes Care, Год журнала: 2025, Номер 48(2), С. 292 - 300

Опубликована: Янв. 22, 2025

OBJECTIVE To provide an updated synthesis on effects of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) weight, BMI, and waist circumference incorporating newer randomized controlled trials (RCTs), particularly in individuals with overweight or obesity. RESEARCH DESIGN AND METHODS We systematically searched PubMed, Embase, Cochrane Central Register Controlled Trials (CENTRAL) for RCTs published from inception to 4 October 2024. The search was limited evaluating the use GLP-1 RAs mean differences baseline adults obesity without diabetes. Two independent reviewers performed literature data extraction, resolving disagreements via consensus third-reviewer consultation. RESULTS Forty-seven were included, a combined cohort 23,244 patients. demonstrated weight reduction −4.57 kg (95% CI −5.35 −3.78), BMI −2.07 kg/m2 −2.53 −1.62), −4.55 cm −5.72 −3.38) compared placebo. This effect consistent across diabetes status, RA used, route administration. greatest treatment benefit appeared favor patients who younger, female, diabetes, higher but lower HbA1c, treated over longer duration. Limitations include substantial statistical heterogeneity, part due broad inclusion criteria. However, this heterogeneity may improve generalizability by reflecting wide range study designs patient populations. CONCLUSIONS significant benefits meta-analysis.

Язык: Английский

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How ‘miracle’ weight‐loss semaglutide promises to change medicine but can we afford the expense?

British Journal of Pharmacology, Год журнала: 2025, Номер unknown

Опубликована: Фев. 13, 2025

Obesity is a complex and growing global concern, affecting one in eight individuals compromising health, quality of life expectancy. It carries significant metabolic, cardiovascular, oncological, hepatorenal, skeletal psychiatric risks, imposing substantial costs on health‐care systems. Traditional treatments have often been ineffective or led to relapse after lifestyle changes. Whereas bariatric surgery effective, it also involves risks such as mortality hospitalisation. Semaglutide, licensed 2018, synthetic analogue glucagon‐like peptide 1 which regulates glucose metabolism gastrointestinal (GI) motility. Studies show that semaglutide, administered either weekly subcutaneously, daily orally, induces an average weight loss −11.62 kg compared placebo reduces waist circumference by up −9.4 cm. improves blood pressure, fasting levels, C‐reactive protein levels lipid profiles. The most common adverse events are mild‐to‐moderate GI complaints occurring more frequently with administration than doses; hypoglycaemia without intervention. Weight regain follows semaglutide withdrawal. Furthermore, offers cardiovascular benefits for patients established atherosclerotic disease (CVD), lowers the risk kidney outcomes cardiovascular‐related death, resolves nonalcoholic steatohepatitis many cases, positively impacts mental health life. In conclusion, therapy could significantly benefit adults regarding CVD if made widely accessible. Ethical financial considerations must be addressed personalised obesity treatment approaches.

Язык: Английский

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Association of glucagon-like peptide 1 analogs and agonists administered for obesity with weight loss and adverse events: a systematic review and network meta-analysis

EClinicalMedicine, Год журнала: 2021, Номер 42, С. 101213 - 101213

Опубликована: Ноя. 27, 2021

Язык: Английский

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Semaglutide delays 4‐hour gastric emptying in women with polycystic ovary syndrome and obesity

Diabetes Obesity and Metabolism, Год журнала: 2022, Номер 25(4), С. 975 - 984

Опубликована: Дек. 13, 2022

To evaluate the effect of once-weekly subcutaneous semaglutide 1.0 mg on late digestive period gastric emptying (GE) after ingestion a standardized solid test meal by using technetium scintigraphy, reference method for this purpose.We conducted single-blind, placebo-controlled trial in 20 obese women with polycystic ovary syndrome (PCOS; mean [range] age 35 [32.3-40.8] years, body mass index 37 [30.7-39.8] kg/m2 ) randomized to once weekly or placebo 12 weeks. GE was assessed [99mT c] colloid pancake labelled radiopharmaceutical scintigraphy sequential static imaging and dynamic acquisition at baseline Week 13. Estimation obtained repeated remaining activity fixed time intervals over course 4 hours ingestion.From study end, increased estimated retention contents 3.5% 1 hour, 25.5% 2 hours, 38.0% 3 30.0% radioactively meal. Four ingestion, retained 37% stomach compared no group (P = 0.002). Time taken half radiolabelled empty from significantly longer than (171 vs. 118 min; P < 0.001).Semaglutide markedly delayed 4-hour PCOS obesity.

Язык: Английский

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GLP-1 receptor agonist as a modulator of innate immunity

Frontiers in Immunology, Год журнала: 2022, Номер 13

Опубликована: Дек. 8, 2022

Glucagon-like peptide-1 (GLP-1) is a 30-amino acid hormone secreted by L cells in the distal ileum, colon, and pancreatic α cells, which participates blood sugar regulation promoting insulin release, reducing glucagon levels, delaying gastric emptying, increasing satiety, appetite. GLP-1 specifically binds to glucagon-like receptor (GLP-1R) body, directly stimulating secretion of β-cells, proliferation differentiation, inhibiting cell apoptosis, thereby exerting glycemic lowering effect. The regulating effect its analogues has been well studied human murine models circumstance many diseases. Recent studies found that able modulate innate immune response number inflammatory In present review, we summarize research progression immunomodulation related signal pathways.

Язык: Английский

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Low Incidence of Pulmonary Aspiration During Upper Endoscopy in Patients Prescribed a Glucagon-Like Peptide 1 Receptor Agonist

Clinical Gastroenterology and Hepatology, Год журнала: 2023, Номер 22(6), С. 1333 - 1335.e2

Опубликована: Дек. 2, 2023

Язык: Английский

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Anesthetic Considerations in Adult Patients on Glucagon-Like Peptide-1 Receptor Agonists: Gastrointestinal Focus

Anesthesia & Analgesia, Год журнала: 2023, Номер unknown

Опубликована: Окт. 24, 2023

From the Department of Anesthesiology and Pain Management, University Texas Southwestern Medical Center, Dallas, Texas. Accepted for publication October 6, 2023. Funding: None. The author declares no conflicts interest. Reprints will not be available from author. Address correspondence to Girish P. Joshi, MBBS, MD, FFARCSI, 5323 Harry Hines Blvd, TX 75390-9068. e-mail [email protected].

Язык: Английский

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Application of Luteolin in Neoplasms and Nonneoplastic Diseases

International Journal of Molecular Sciences, Год журнала: 2023, Номер 24(21), С. 15995 - 15995

Опубликована: Ноя. 6, 2023

Researchers are amazed at the multitude of biological effects 3′,4′,5,7-tetrahydroxyflavone, more commonly known as luteolin, it simultaneously has antioxidant and pro-oxidant, well antimicrobial, anti-inflammatory, cancer-preventive, properties. The anticancer properties luteolin constitute a mosaic pathways due to which this flavonoid influences cancer cells. Not only is able induce apoptosis inhibit cell proliferation, but also suppresses angiogenesis metastasis. Moreover, succeeds in sensitization therapeutically induced cytotoxicity. Nevertheless, apart from its promising role chemoprevention, exhibits numerous potential utilizations patients with conditions other than neoplasms, include inflammatory skin diseases, diabetes mellitus, COVID-19. This review aims present multidimensionality luteolin’s impact on both neoplastic nonneoplastic diseases. When comes we intend describe complexity molecular mechanisms that underlay effectiveness, prove usefulness integrating therapy via analysis recent research breast, colon, lung cancer. Regarding emphasize importance researching areas such diabetology, virology, dermatology summarizes most important discoveries those fields regarding application.

Язык: Английский

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