S740 Knowledge, Attitudes, and Practices Regarding Semaglutide Use in the US: A Nationwide Survey With Emphasis on Gastrointestinal Adverse Effects

Introduction: Semaglutide, a GLP-1 receptor agonist approved for type 2 diabetes mellitus, has seen rapidly increasing off-label use for weight loss, driven by social media promotion and celebrity endorsements. However, its gastrointestinal (GI) adverse effects-including gastroparesis, pancreatitis, and severe nausea-remain under-recognized in clinical practice. This study evaluates the knowledge, attitudes, and practices (KAP) surrounding semaglutide use in the United States, with particular focus on GI risks, monitoring behaviors, and gaps in patient and provider awareness. Methods: We conducted a stratified, web-based survey from 2023-2024 of 1,200 U.S. adults, including 800 patients, 300 physicians (of whom 50 were gastroenterologists), and 100 pharmacists. Survey domains assessed knowledge of FDA indications and GI adverse effects, attitudes toward risks and benefits, and real-world prescribing and monitoring practices. Multivariable logistic regression was used to identify predictors of off-label use and inadequate GI symptom monitoring, adjusting for age, gender, and provider specialty. Results: Only 38% of patients correctly identified gastroparesis as a potential adverse effect of semaglutide, while gastroenterologists were 2.1 times more likely than primary care providers to discuss GI risks with patients (95% CI: 1.4-3.2, P < 0.001). A concerning 62% of patients perceived semaglutide as “low risk” for GI complications, despite 22% reporting persistent vomiting or constipation after initiation. Notably, only 30% of symptomatic patients received appropriate GI evaluation. Off-label use was significantly higher among patients under 35 years old (OR: 2.3, P < 0.01). Among providers, 45% expressed concern about potential long-term motility disorders associated with GLP-1 agonist use, yet many continued to prescribe off-label due to patient demand. Conclusion: Study reveals critical gaps in recognizing semaglutide's GI risks (gastroparesis/pancreatitis), with only 38% of patients aware. Gastroenterologists show better awareness than other providers. Troubling trends: 2.3× higher off-label use in young adults (P < 0.01) and only 30% of symptomatic patients receiving GI evaluation. Despite 62% perceiving semaglutide as 'low-risk,' urgent action is needed. We propose: 1) ACG guidelines for GLP-1 agonist GI monitoring, and 2) targeted patient education on risks. These interventions address knowledge gaps in managing these increasingly common adverse effects.