Association of GLP-1 Receptor Agonist Use With Risk of Lumbar Degenerative Disease and Spine Surgery in Patients With Type 2 Diabetes: A Propensity Score–matched Cohort Study

Study DesignRetrospective propensity score-matched cohort study.ObjectivesTo investigate whether the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) is associated with a reduced risk of lumbar degenerative disease (LDD) and lumbar spine surgery in patients with type 2 diabetes mellitus (T2DM).MethodsData were obtained from the TriNetX Global Collaborative Network. Adult patients with T2DM initiating GLP-1 RA therapy were matched 1:1 with non-users based on demographics, comorbidities, and medication use. Patients with pre-existing LDD or prior lumbar spine surgery were excluded. Primary outcome was the incidence of LDD; secondary outcome was lumbar spine surgery. Outcomes were assessed at 3- and 5-year intervals, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.ResultsA total of 196 435 matched pairs were analyzed. At 3 years, GLP-1 RA users had a lower incidence of LDD (11.9% vs 13.3%; OR 0.89, 95% CI: 0.87-0.91). At 5 years, this difference widened (14.6% vs 18.7%; OR 0.74, 95% CI: 0.73-0.74). Lumbar spine surgery rates were similar at 3 years (0.4% in both groups; OR 1.03, 95% CI: 0.93-1.14), but significantly lower in GLP-1 RA users at 5 years (0.5% vs 0.6%; OR 0.86, 95% CI: 0.78-0.92).ConclusionsGLP-1 RA use is associated with a lower long-term risk of developing LDD and undergoing lumbar spine surgery in patients with T2DM. These findings support further investigation of GLP-1 RAs as potential disease-modifying agents in spinal health.