School of Podiatric Medicine - Student Research

Document Type

Poster

Publication Date

Fall 9-27-2025

Abstract

Poster Category:  Non-sponsored

Level of Evidence:  Level V

Introduction:  GLP-1 receptor agonists (GLP-1 RAs), widely used for glycemic control and weight management in Type 2 Diabetes Mellitus (T2DM), slow gastric motility.

Reports of “gastroparesis” in GLP-1 RA users raise the question whether this reflects reversible pharmacologic effects or true diabetic autonomic neuropathy. This distinction matters for podiatric physicians, as gastroparesis indicates systemic autonomic dysfunction that parallels peripheral neuropathy, impaired wound healing, and heightened foot ulcer risk. Most prior studies rely on symptoms rather than validated gastric emptying (GE) measures.

Aim:  To evaluate the association between GLP-1 RA use and gastroparesis in T2DM through studies employing objective GE assessments.

Methods:  A scoping review of PubMed and Google Scholar (2020–2025) was performed. Inclusion criteria were adult T2DM studies with GLP-1 RA exposure and validated GE testing (scintigraphy, 13C breath test, acetaminophen absorption). Exclusion criteria were non-English language, pre-2020 publication, reviews, or absence of GE outcomes.

Results:  There were 169 records identified and 39 duplicates removed, leaving 130 records for screening. Twenty underwent full-text review, and seven met inclusion. Agents studied included oral semaglutide and injectable lixisenatide, exenatide, liraglutide, dulaglutide, efpeglenatide, and tirzepatide. All agents produced measurable delays in GE, but the magnitude varied. Short-acting daily agents such as lixisenatide produced the most dramatic effect, with scintigraphy showing up to 48% retention at 4 hours. Long-acting weekly agents caused acute slowing that attenuated with chronic use. Findings were consistent in obese Western cohorts (BMI ~30–35) and leaner Japanese cohorts (BMI ~24–27), indicating the effect is not obesity-dependent.

Conclusions:  GLP-1 RAs delay GE in T2DM, with effects varying by formulation and duration. Validated GE studies suggest many “gastroparesis” cases may represent drug-induced delay rather than irreversible neuropathy. For podiatric physicians, distinguishing between the two is essential for accurate risk assessment, ulcer prevention, and perioperative safety.

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