Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a class of medications used to treat and manage type 2 diabetes mellitus (T2DM) and obesity. The present narrative review explores potential interactions between the gut microbiome and GLP-1 RAs. Limited research has been conducted at the intersection of the gut microbiome and GLP-1 RA therapy. Therefore, this review focuses on potential relationships among GLP-1 RA, the microbiome, body weight, dietary changes, and gastrointestinal symptoms. The review of the current literature reveals significant gaps, particularly concerning the role of diet in mediating or confounding any impact of GLP-1 RA medications on the gut microbiome. Therefore, the body of the review is structured as a series of proposed directional and causal relationships. The limited available evidence suggests changes in behavior, diet, and weight loss resulting from GLP-1 RA treatment are the primary drivers of microbiome changes observed after GLP-1 RA treatment. The review concludes by proposing directions for future studies to clarify the complex interplay between GLP-1 RAs, the gut microbiome, diet, and obesity management.
Johnson et al. (2026) studied this question.