S1098 Increased Diagnoses of IBS and Functional Dyspepsia in Patients With Uncomplicated Diabetes Mellitus on GLP-1 Receptor Agonists: A Propensity-Matched Cohort Analysis

Introduction: Glucagon-like peptide-1 receptor agonists (GLP1-RAs) are widely used in patients with type 2 diabetes mellitus (T2DM) and obesity. While their gastrointestinal (GI) adverse events are well recognized, their association with irritable bowel syndrome (IBS) and functional dyspepsia (FD) remains underexplored. We aim to assess the incidence of IBS and FD diagnoses in patients with uncomplicated T2DM treated with GLP1-RAs compared to matched controls. Methods: A retrospective cohort study was performed using the TriNetX database. Adults (aged ≥18 years) with uncomplicated T2DM between 2015 and 2020 were included. Patients with complicated DM, gastroparesis, peptic ulcer disease, inflammatory bowel disease, celiac disease, GI malignancies, prescription of insulin or chronic opioids, or prior diagnosis of IBS or FD were excluded. Two cohorts were defined: 1) Patients receiving GLP1-RAs (semaglutide, liraglutide, and dulaglutide) with at least 3 documented prescriptions, and 2) Controls receiving oral antihyperglycemic agents. Propensity score matching (PSM) was employed to balance demographic and clinical variables. The primary outcome was new IBS and FD diagnoses at 1-, 3-, and 5-years after continuous GLP-1 RAs. Secondary outcomes included EGD ± colonoscopy and IBS-related medications within 5 years. Results: After PSM, 8,409 patients were included in each group. BMI was slightly higher in the GLP-1-RAs group compared to controls [36.1 vs 34.3], while HbA1c was comparable; 8.17 vs 8.34. While there was no significant difference in new IBS (aOR 1.21; 95% CI 0.71–2.10) or FD diagnoses (aOR 1.08; 95% CI 0.51–2.29) at 1 year, GLP1-RAs were associated with significantly higher incidence of IBS and FD diagnoses at 3 years [IBS (aOR 1.61; 95% CI 1.10–2.69), FD (aOR 1.95; 95% CI 1.14–3.35)] and 5 years [IBS (aOR 1.68; 95% CI 1.16–2.42), FD (aOR 1.67; 95% CI 1.04–2.69)], respectively. Within 5 years, GLP1-RAs use was associated with a significant increase in esophagogastroduodenoscopy and/or colonoscopy utilization (aOR 1.97; 95% CI 1.71–2.26) along with prescription of IBS-related pharmacotherapy (aOR 1.72; 95% CI 1.51–1.96). Conclusion: GLP1-RAs are associated with a significantly higher incidence of IBS and FD International Classification of Diseases diagnoses, endoscopic procedures, and IBS-related medications in patients with uncomplicated T2DM. Although absolute rates were low, the relative increases suggest a potential for GLP1-RAs-related GI symptoms to be misclassified as IBS and FD. Further studies are warranted to clarify this association.