In patients with type 2 diabetes undergoing orthopedic shoulder procedures, DPP-4 inhibitor use was associated with significantly higher early postoperative opioid use compared to GLP-1 receptor agonists (RR 1.754).
Cohort (n=1,264)
Yes
Does the use of dipeptidyl peptidase-4 (DPP-4) inhibitors compared to glucagon-like peptide-1 (GLP-1) receptor agonists affect reoperation rates and postoperative opioid use in adults with type 2 diabetes undergoing orthopedic shoulder surgery?
In patients with type 2 diabetes undergoing orthopedic shoulder surgery, GLP-1 receptor agonists and DPP-4 inhibitors yield similar long-term reoperation rates, but GLP-1 agonists are associated with significantly lower early postoperative opioid requirements.
Relative Risk: 1.754 (95% CI 1.44–2.137)
Absolute Event Rate: 32.8% vs 18.7%
p-value: p=<0.001
Background: Diabetes mellitus is an independent risk factor for complications following orthopedic shoulder procedures. Dipeptidyl peptidase-4 (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists are effective agents that manage type 2 diabetes, but their differential effects on perioperative and long-term shoulder outcomes remain unclear. Methods: We conducted a retrospective cohort study using the TriNetX Research Network, identifying adults (≥18 years) with type 2 diabetes who underwent orthopedic shoulder procedures and were prescribed either a DPP-4 inhibitor or a GLP-1 receptor agonist. Propensity score matching was performed (1:1), adjusting for demographics, comorbidities, and procedure type, yielding 632 patients per cohort. Outcomes included rates of reoperation at one and two years postoperatively and postoperative opioid use. Results: At one- and two-year follow-up, rates of reoperation were similar between cohorts. DPP-4 users had significantly higher early postoperative opioid use compared with GLP-1 users (RR: 1.754; 95% CI: 1.440-2.137; p < 0.001), whereas prolonged and chronic postoperative opioid use were similar between cohorts. Conclusion: In patients with type 2 diabetes undergoing orthopedic shoulder procedures, DPP-4 inhibitors and GLP-1 receptor agonists demonstrated comparable long-term surgical outcomes, including reoperation rates at one and two years postoperatively. However, early postoperative opioid use was significantly higher among DPP-4 users, while prolonged and chronic opioid utilization were similar between cohorts. These findings support the perioperative safety of both incretin-based therapies and suggest that GLP-1 receptor agonists may confer additional benefit through potential central pain-modulating effects that reduce early postoperative opioid requirements.
Mahatme et al. (Mon,) conducted a cohort in Type 2 diabetes mellitus undergoing orthopedic shoulder procedures (n=1,264). Dipeptidyl Peptidase-4 (DPP-4) Inhibitors vs. Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists was evaluated on Early postoperative opioid use (1-30 days) (RR 1.754, 95% CI 1.440-2.137, p=<0.001). In patients with type 2 diabetes undergoing orthopedic shoulder procedures, DPP-4 inhibitor use was associated with significantly higher early postoperative opioid use compared to GLP-1 receptor agonists (RR 1.754).