Diabetes Care

GLP-1 RAs and DPP-4is linked to biliary events, but not pancreatitis

December 4, 2025

A claims-based analysis of over 3.6 million adults with T2DM found no increased risk of acute pancreatitis (AP) with GLP-1 RAs or DPP-4is compared with SGLT2 inhibitors (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.90-1.13 and HR, 1.00; 95% CI, 0.85-1.15, respectively). However, both incretin classes were associated with a modest rise in biliary disease risk vs. SGLT2is (HR, 1.15 and 1.22, respectively), equating to fewer than one additional event per 1,000 person-years. Risk was comparable between GLP-1RAs and DPP-4is for both AP and biliary disease.

Clinical takeaway: Monitor for biliary complications when prescribing incretin-based agents, though absolute risk remains low.

Source:

Fang YE, et al. (2025, October 27). Diabetes Care. Risk of Acute Pancreatitis and Biliary Events After Initiation of Incretin-Based Medications in Patients With Type 2 Diabetes. https://pubmed.ncbi.nlm.nih.gov/41144235/