Risk of Acute Pancreatitis and Biliary Events After Initiation of Incretin-Based Medications in Patients With Type 2 Diabetes
Authors' conclusion
In patients with T2D, GLP-1RAs and DPP-4is were associated with a small increase in risk of biliary disease, but not of AP, compared with SGLT2is.
Study context
- Population
- Adults aged ≥18 years (≥65 years in Medicare Fee-for-Service (FFS)) with T2D without prior acute pancreatitis or biliary disease; Medicare FFS and two US commercial claims databases (2014–2021)>1.2 million per cohort
- Exposure
- GLP-1 RA vs SGLT2i, DPP-4i vs SGLT2i, GLP-1 RA vs DPP-4i
- Outcome
- Hospitalization because of acute pancreatitis and biliary events
Methodological detailspropensity score fine stratification-weighted, three pairwise cohorts, active comparator new-user
- Propensity score fine stratification-weighted
- Three pairwise cohorts
- Active comparator new-user
Main finding
As reported in the abstract
Estimate (95% CI)
GLP-1RAsvs SGLT2is
HR (acute pancreatitis) 1.01(0.90–1.13)
DPP-4isvs SGLT2is
HR (acute pancreatitis) 1.00(0.85–1.15)
GLP-1RAsvs SGLT2is
HR (biliary disease) 1.15(1.05–1.26)
DPP-4isvs SGLT2is
HR (biliary disease) 1.22(1.03–1.46)
GLP-1RAsvs DPP-4is
HR (acute pancreatitis) 1.08(0.95–1.22)
GLP-1RAsvs DPP-4is
HR (biliary disease) 0.95(0.86–1.04)
Observational data: associations, not effects.
Original publication
Risk of Acute Pancreatitis and Biliary Events After Initiation of Incretin-Based Medications in Patients With Type 2 Diabetes. Diabetes Care. Published 27 October 2025. doi:10.
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