GLP-1 receptor agonist safety in a perioperative setting : more questions than answers

Abstract

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are among the latest class of drugs to be approved for the management of type 2 diabetes mellitus (T2DM). Their use has rapidly increased as their indications were expanded to include obesity management (Table 1). In 2005, the United States Food and Drug Administration (FDA) approved exenatide, and since then, GLP-1 RA use has expanded to include agents such as liraglutide (Saxenda), semaglutide (Ozempic, Wegovy), and the dual GLP-1/GIP agonist tirzepatide (Mounjaro). In 2021, semaglutide became the first GLP-1 RA approved for chronic weight management, with similar authorizations following in the European Union. Their increasing use has prompted questions on their safety in certain scenarios such as the perioperative setting. The same pharmacological properties that confer therapeutic benefits may inadvertently create challenges in this setting. [excerpt]