Impact of glucagon-like peptide-1 receptor agonists on bowel preparation quality for colonoscopy in type 2 diabetes

Table 1 Characteristics of glucagon-like peptide-1 receptor agonist and dipeptidyl peptidase-4 inhibitor users before and after matching, mean ± SD/n (%)

	Before matching (n = 589)					After matching (n = 341)
	Total (n = 589)	GLP-1RA (n = 153)	DPP-4i (n = 436)	ASMD	P value	Total (n = 341)	GLP-1RA (n = 133)	DPP-4i (n = 208)	ASMD	P value
Age (years)	64.4 ± 9.3	60.7 ± 10.0	65.6 ± 8.7	0.524	< 0.001	62.7 ± 9.1	61.5 ± 9.5	63.5 ± 8.8	0.227	0.434
Sex (male)	382 (64.9)	103 (67.3)	279 (64.0)	0.070	0.520	220 (64.5)	89 (66.9)	131 (63.0)	0.083	0.749
BMI (kg/m2)	25.3 ± 3.8	26.4 ± 3.9	24.9 ± 3.6	0.390	< 0.001	25.6 ± 3.7	26.1 ± 3.4	25.3 ± 3.9	0.214	0.597
HbA1c (%)	7.0 ± 1.1	7.3 ± 0.9	6.9 ± 1.1	0.390	< 0.001	7.2 ± 1.0	7.3 ± 0.9	7.1 ± 1.0	0.208	0.965
HbA1c ≥ 7% (%)	250 (42.4)	96 (62.7)	154 (35.3)	0.570	< 0.001	188 (55.1)	82 (61.7)	106 (51.0)	0.217	1.000
Insulin use	124 (21.1)	58 (37.9)	66 (15.1)	0.534	< 0.001	99 (29.0)	48 (36.1)	51 (24.5)	0.254	0.609
Metformin use	478 (81.2)	150 (98.0)	328 (75.2)	0.711	< 0.001	329 (96.5)	130 (97.7)	199 (95.7)	0.116	0.768
Bowel preparation
PEG solutions	583 (99.0)	151 (98.7)	432 (99.1)	0.037	0.653	337 (98.8)	131 (98.5)	206 (99.0)	0.049	0.700
Non-PEG solutions	6 (1.0)	2 (1.3)	4 (0.9)			4 (1.2)	2 (1.5)	2 (1.0)
DM duration	14.5 ± 8.9	16.8 ± 8.4	13.7 ± 9.0	0.352	< 0.001	16.3 ± 9.0	16.5 ± 8.3	16.2 ± 9.4	0.041	0.587
DM complication	219 (37.2)	71 (46.4)	148 (33.9)	0.256	0.008	135 (39.6)	59 (44.4)	76 (36.5)	0.160	0.778
Hypertension	387 (65.7)	100 (65.4)	287 (65.8)	0.010	0.996	218 (63.9)	85 (63.9)	133 (63.9)	0.001	0.768
Chronic kidney disease	130 (22.1)	16 (10.5)	114 (26.1)	0.414	< 0.001	47 (13.8)	15 (11.3)	32 (15.4)	0.121	0.888
Cardiovascular disease	90 (15.3)	18 (11.8)	72 (16.5)	0.137	0.203	50 (14.7)	16 (12.0)	34 (16.3)	0.124	0.218
Cerebrovascular accident	127 (21.6)	34 (22.2)	93 (21.3)	0.022	0.907	70 (20.5)	31 (23.3)	39 (18.8)	0.112	0.269
GI modulator
Increasing motility1	51 (8.7)	16 (10.5)	35 (8.0)	0.084	0.452	27 (7.9)	14 (10.5)	13 (6.3)	0.155	0.124
Decreasing motility2	17 (2.9)	2 (1.3)	15 (3.4)	0.140	0.262	7 (2.1)	1 (0.8)	6 (2.9)	0.160	0.340

¹Gastrointestinal modulators increasing motility included prokinetic agents, and laxative agents.

²Gastrointestinal modulators decreasing motility included tricyclic antidepressants, opioids, anticholinergic agents and antidiarrheal agents.

BMI: Body mass index; HbA1c: Hemoglobin A1c; PEG: Polyethylene glycol; DM: Diabetes mellitus; GI: Gastrointestinal; ASMD: Absolute standardized mean difference; DPP-4i: Dipeptidyl peptidase-4 inhibitor; GLP-1RA: Glucagon-like peptide-1 receptor agonist.

Table 2 Procedural outcomes of glucagon-like peptide-1 receptor agonist users and dipeptidyl peptidase-4 inhibitor users before and after matching, mean ± SD/n (%)

	Before matching (n = 589)				After matching (n = 341)
	Total (n = 589)	GLP-1RA (n = 153)	DPP-4i (n = 346)	P value	Total (n = 341)	GLP-1RA (n = 133)	DPP-4i (n = 208)	P value
Total BBPS	6.9 ± 1.7	6.6 ± 2.0	7.0 ± 1.7	0.058	6.8 ± 1.8	6.6 ± 2.0	7.0 ± 1.6	0.116
Segment BBPS
Left	2.4 ± 0.7	2.3 ± 0.8	2.4 ± 0.7	0.051	2.3 ± 0.8	2.2 ± 0.8	2.4 ± 0.7	0.275
Transverse	2.5 ± 0.6	2.4 ± 0.7	2.5 ± 0.6	0.342	2.5 ± 0.6	2.4 ± 0.7	2.5 ± 0.6	0.413
Right	2.0 ± 0.7	1.9 ± 0.8	2.1 ± 0.7	0.026	2.0 ± 0.7	1.9 ± 0.8	2.1 ± 0.7	0.031
Inadequate bowel preparation1	102 (17.3)	36 (23.5)	66 (15.1)	0.025	66 (19.4)	34 (25.6)	32 (15.4)	0.034
Aborted colonoscopy	5 (0.8)	2 (1.3)	3 (0.7)	0.609	3 (0.9)	2 (1.5)	1 (0.5)	0.569
Repeat colonoscopy	5 (0.8)	2 (1.3)	3 (0.7)	0.609	3 (0.9)	2 (1.5)	1 (0.5)	0.569

¹Inadequate bowel preparation was defined as total Boston Bowel Preparation Scale score < 6 or any segment of Boston Bowel Preparation Scale score < 2.

BBPS: Boston Bowel Preparation Scale; DPP-4i: Dipeptidyl peptidase-4 inhibitor; GLP-1RA: Glucagon-like peptide-1 receptor agonist.

Table 3 Multivariable analysis of risk factors for inadequate bowel preparation

	Propensity matched patients (n = 341)
	Unadjusted OR (95%CI)	P value	Adjusted OR (95%CI)	P value
GLP-1RA	1.85 (1.05-3.27)	0.034	1.89 (1.05-3.39)	0.034
Age	1.02 (0.99-1.06)	0.239	1.03 (0.99-1.06)	0.149
Sex (male)	2.44 (1.23-4.82)	0.011	2.46 (1.24-4.89)	0.010
BMI	1.39 (0.19-10.16)	0.746	0.93 (0.11-7.91)	0.948
HbA1c	0.31 (0.02-3.90)	0.362	0.21 (0.01-3.27)	0.265
Insulin use	1.39 (0.77-2.52)	0.277	1.45 (0.81-2.59)	0.210
DM complication	0.72 (0.40-1.29)	0.264
DM duration	1.02 (0.93-1.12)	0.625
Hypertension	1.25 (0.68-2.30)	0.479
Chronic kidney disease	0.77 (0.30-1.95)	0.577
Cardiovascular disease	1.55 (0.75-3.22)	0.241
Cerebrovascular accident	1.32 (0.68-2.57)	0.412
GI modulator
Increasing motility1	1.55 (0.60-3.98)	0.363
Decreasing motility2	0.69 (0.08-6.07)	0.738

¹Gastrointestinal modulators increasing motility included prokinetic agents and laxative agents.

²Gastrointestinal modulators decreasing motility included tricyclic antidepressants, opioid medications, anticholinergic agents and antidiarrheal agents.

GLP-1RA: Glucagon-like peptide-1 receptor agonist; BMI: Body mass index; HbA1c: Hemoglobin A1c; DM: Diabetes mellitus; GI: Gastrointestinal; CI: Confidence interval; OR: Odds ratio.

Table 4 Association between glucagon-like peptide-1 receptor agonist subtype and the risk of inadequate bowel preparation

	Propensity matched patients (n = 133)
	Unadjusted OR (95%CI)	P value	Adjusted OR (95%CI)	P value
GLP-1RA
Dulaglutide 0.75 mg	Reference	0.587	Reference	0.410
Dulaglutide 1.5 mg	1.66 (0.67-4.14)	0.273	1.85 (0.72-4.72)	0.201
Liraglutide 3.6 mg/1 mL	4.13 (0.23-73.30)	0.334	4.72 (0.40-56.23)	0.220
Liraglutide 18 mg/3 mL	1.03 (0.18-5.83)	0.972	0.98 (0.14-6.78)	0.986

CI: Confidence interval; GLP-1RA: Glucagon-like peptide-1 receptor agonist; OR: Odds ratio.