Association of GLP ‐1 Receptor Agonists With Hepatic Decompensation in the All of Us Research Program
Authors' conclusion
In this diverse nationwide cohort, initiation of GLP-1RAs was associated with a significantly reduced risk of hepatic decompensation compared with DPP4is. These findings extend prior evidence by demonstrating this association in a cohort enriched for populations historically underrepresented in biomedical research.
Study context
- Population
- Adults with T2D initiating GLP-1 RAs or DPP-4is without prior hepatic decompensation or competing causes of chronic liver disease, NIH All of Us Research Program; mean age 57.3 years, 58.8% female, 24.8% Black or African Americanmatched cohort
- Participants
- 7,854 adults
- Exposure
- GLP-1 RA initiation vs DPP-4i
- Outcome
- Composite of hepatic decompensation events (oesophageal varices with bleeding, ascites, hepatic encephalopathy, hepatic failure, or liver transplantation)
Methodological detailsactive-comparator new-user, stratified propensity score matching (1:1)
- Active-comparator new-user
- Stratified propensity score matching (1:1)
Main finding
As reported in the abstract
Hepatic decompensation
Each group vs DPP4iHazard ratio (95% CI)P value
GLP-1RA
0.67(0.47–0.95)
P = 0.026- GLP-1RA
- absolute rate difference −1.66 events per 1000 person-years
Observational data: associations, not effects.
Further findings
Prespecified sensitivity analyses
- Estimates were directionally similar
Original publication
Association of GLP ‐1 Receptor Agonists With Hepatic Decompensation in the All of Us Research Program. Diabetes Obes Metab. Published 18 March 2026. doi:10.
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