S48 Guts, Glucose, and Gallbladders: The Protective Role of GLP-1/GIP Receptor Agonists Against Biliary Complications in Patients With Type 2 Diabetes and Inflammatory Bowel Disease

Introduction: Type 2 diabetes mellitus (T2DM) and inflammatory bowel disease (IBD) frequently coexist, presenting unique challenges in clinical management due to overlapping inflammatory and metabolic pathways. GLP-1 receptor agonists and dual GLP-1/GIP agonists are increasingly utilized for glycemic control and weight management in T2DM. While their effects on gastrointestinal outcomes have been broadly studied, limited data exist on their impact on biliary complications in patients with coexisting IBD. This study aims to address this gap by evaluating biliary outcomes in patients with T2DM and IBD who were treated with GLP-1/GIP agonists compared to those who were not. Methods: This retrospective cohort study utilized the TriNetX global health research network. Adults (≥18 years) with both T2DM and IBD (Crohn’s disease or ulcerative colitis) were grouped into 2 cohorts: those prescribed GLP-1/GIP receptor agonists (semaglutide or tirzepatide) and those not. The index date was the first date meeting inclusion criteria; outcomes were assessed from 1-day post-index. Propensity score matching (1:1) was performed using variables including: Demographics: age, sex, race, ethnicity. Comorbidities: cardiovascular, renal, pulmonary, hepatic, oncologic, infectious, autoimmune, and GI-related conditions. Procedures: GI surgeries. Medications: insulin, oral antidiabetics, and SGLT2/DPP-4 inhibitors. Results: Patients treated with GLP-1/GIP receptor agonists demonstrated significantly lower risks for several biliary complications: Cholelithiasis: RR 0.51 (95% CI: 0.45–0.58), P < 0.001. Cholecystitis: RR 0.33 (95% CI: 0.26–0.41), P < 0.001. Choledocholithiasis: RR 0.34 (95% CI: 0.25–0.45), P < 0.001. Cholangitis: RR 0.42 (95% CI: 0.20–0.87), P = 0.016. Perforation, Sphincter Spasm, and Biliary Cyst: All showed lower or zero incidence in the treatment group (P ≤ 0.002). Conclusion: GLP-1 and dual GLP-1/GIP receptor agonist therapy in patients with T2DM and IBD is associated with significantly lower risks of biliary complications. These findings highlight a potential protective effect and support broader use of these agents in patients at elevated risk for biliary disease.