(B-123) Use of Glucagon-like Peptide 1 Agonists (GLP-1's) Among Individuals Undergoing Bariatric Surgery In The United States: A Retrospective Cohort Study

Background: Although randomized and well-controlled studies demonstrate the efficacy of glucagon-like peptide-1 receptor agonist (GLP-1s) for weight management after bariatric surgery, little is known regarding the frequency and predictors of such use.

Objectives: To characterize use and factors associated with GLP-1 initiation among U.S. adults undergoing bariatric surgery.

Methods: We performed a retrospective cohort study using TriNetX, a large and diverse U.S. electronic health records repository. We included adults undergoing Roux-en-y gastric bypass or sleeve gastrectomy, which are the most common procedures with specified identification codes, between January 1, 2015, and May 31, 2023, without GLP-1 use during the 12-months prior to surgery. We followed each individual from their index date, defined as the date of first bariatric surgery, to the first receipt of GLP-1, death, or end of the study period, i.e., May 31, 2025, whichever occurred first. We used descriptive statistics and Kaplan Meier analysis to quantify GLP-1 initiation after surgery, and Cox proportional hazards model to identify baseline patient characteristics and bariatric surgery associated with GLP-1 initiation. Among individuals with at least two BMI post-bariatric surgery, we used the time-dependent Cox proportional hazards model to examine the association of post-surgery BMI with GLP-1 initiation.

Results: Among 112,858 individuals undergoing bariatric surgery, 15,749 (14.0%) initiated GLP-1s after surgery. Of initiators, approximately 21% began within two years of surgery, with the remainder initiating GLP1s during years 3-4 (32%), years 5-6 (25%) or beyond (21%). The overall median BMI at the GLP-1 initiation was 42.0 kg/m2 (interquartile range [IQR] 38.3 – 45.6). In regression model, females (adjusted hazard ratio [aHR] 1.61, 95% confidence intervals [CI] 1.54 to 1.69), those undergoing sleeve gastrectomy (aHR 1.42, CI 1.37 to 1.47) and those with type 2 diabetes (aHR 1.34, CI 1.28 to 1.39) were more likely to initiate GLP-1 than their counterparts. Each 1 kg/m2 increase in post-surgical BMI was associated with a 8% increase in GLP-1 initiation risk (aHR 1.08, CI 1.08 to 1.08).

Conclusions: Among our cohort undergoing bariatric surgery, approximately one in ten initiated a GLP-1. Initiation was greater among women, those undergoing sleeve gastrectomy and individuals with larger BMI regain than among their counterparts.