Association of GLP-1 receptor agonist use with clinical outcomes in necrotizing soft tissue infections among patients with type 2 diabetes

Patients with type 2 diabetes are prone to necrotizing soft tissue infections (NSTIs). The clinical outcomes of NSTIs are poor, with high mortality and morbidity. The association between the use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and outcomes in these patients remains unclear. We conducted a retrospective database analysis including patients with type 2 diabetes (ICD-10 E11) who had used GLP-1RAs within six months before the diagnosis of NSTIs. Patients younger than 18 years and those with NSTI diagnoses more than 20 years earlier were excluded. Short- and mid-term outcomes including all-cause mortality, major adverse cardiovascular events, acute respiratory distress syndrome, acute kidney injury, need of blood transfusion, and amputation were compared after propensity score matching. A total of 16,792 patients were included. After propensity score matching, 1,099 patients remained in each group with balanced baseline characteristics. The use of GLP-1RAs was associated with lower mortality at three months (HR 0.49, 95% CI 0.30–0.82) and six months follow up (HR 0.53, 95% CI 0.34–0.82). GLP-1RA users had a significantly lower risk of short-term acute respiratory distress syndrome (OR 0.54, 95% CI 0.30–0.96). The risk of amputation was significantly lower among GLP-1RA users, with ORs of 0.69 (95% CI, 0.49–0.97) at three months and 0.67 (95% CI, 0.48–0.93) at six months. However, no significant differences were observed for other secondary outcomes. GLP-1RA therapy was associated with a lower risk of mortality among patients with type 2 diabetes who developed NSTIs. However, residual confounding cannot be excluded, and causal relationships cannot be established from this retrospective study. Further studies are needed to clarify their role in predicting clinical outcomes. Not applicable.