GLP‑1 receptor agonist therapy and 2‑year structural outcomes after arthroscopic rotator cuff repair in type 2 diabetes

BACKGROUND: The peri‑operative management of glucagon‑like peptide‑1 receptor agonists (GLP‑1RAs) in orthopaedic surgery is controversial, and evidence regarding their influence on tendon healing after rotator cuff repair (RCR) is limited. Previous studies have mainly addressed incident rotator cuff tear or primary RCR, and one analysis reported no increase in reoperation among GLP‑1RA users. Whether pre‑index GLP‑1RA use affects tendon healing after arthroscopic RCR in patients with type 2 diabetes mellitus (T2DM) remains unclear. METHODS: Using the TriNetX Global Collaborative Network, a federated electronic medical record network comprising over 170 healthcare organizations, we identified adults with T2DM undergoing arthroscopic RCR (CPT 29827). In clinical practice, arthroscopic RCR is predominantly used for repairable small‑to‑large tears, whereas massive or irreparable tears are often managed with alternative procedures. GLP-1RA new users (prescriptions ≤ 6 months before index) were compared with an active-comparator diabetes therapy using 1:1 propensity score matching to balance age, sex, BMI, HbA1c, and key comorbidities. The primary outcome was 2-year revision surgery; the secondary outcome was a retear-proxy event (ICD-10 M75.1 plus MRI). Risks, risk ratios (RRs), and Cox hazard ratios (HRs) were estimated. RESULTS: After matching, 957 patients remained in each cohort with standardized mean differences < 0.1 for all covariates. Two‑year revision occurred in 10 GLP‑1RA users (1.0%) and 11 comparators (1.1%; RR 0.91, 95% confidence interval [CI] 0.39-2.13; HR 0.91, 95% CI 0.39-2.15). The retear‑proxy event occurred in 70 (7.3%) versus 82 (8.6%) patients (RR 0.85, 95% CI 0.63-1.16; HR 0.85, 95% CI 0.62-1.17). Kaplan-Meier curves and log‑rank tests showed no significant differences for either endpoint. CONCLUSIONS: In T2DM patients undergoing arthroscopic RCR, pre-index GLP-1RA use was not associated with a detectable increase in 2-year risk of revision surgery or retear-proxy events compared with active-comparator non-GLP-1 therapy. These findings are consistent with the short-term structural safety of GLP-1RAs after RCR but should be interpreted with caution given the low number of revision events and the inherent limitations of the database. LEVEL OF EVIDENCE: Level III.