The edition · Diabetes & Endocrinology
On a GLP-1 agonist and needing an opioid: oxycodone carried the most bowel trouble
A 411,000-patient claims cohort compares opioids in GLP-1RA users, compounded semaglutide vials are recalled for particulate matter, and waist circumference beats BMI at spotting diabetes in 82 low- and middle-income countries.
The edition in brief
In 411,188 US adults with type 2 diabetes on a GLP-1 receptor agonist, starting oxycodone was associated with a 0.51% 30-day risk of severe constipation, bowel obstruction or gastroparesis, against 0.35% for hydrocodone and 0.33% for tramadol (RR 1.55 vs tramadol). The absolute difference is small, about 1 extra event per 550 prescriptions, and the design is observational. The FDA lists a Class II recall of compounded semaglutide multi-dose vials from Apollo Care for nylon and protein-type particulate matter. A Bayesian meta-analysis of 10 tirzepatide trials (6,515 people) found no clear signal for atrial fibrillation (OR 2.20, 95% CrI 0.81 to 6.75), though any arrhythmia reached OR 1.84 on few events. Across 48 SGLT2 inhibitor trials, gastrointestinal neoplasms were not increased (OR 1.10, 0.84 to 1.44, I² = 0%), with short follow-up. In 77 adults with type 1 diabetes on automated insulin delivery, insulin needs rose and time in range fell in the luteal phase. And across 598,883 adults with BMI 18.5 to 29.9 in 82 low- and middle-income countries, waist circumference classified diabetes better than BMI (AUC 0.69 vs 0.64 in men, 0.69 vs 0.63 in women), which supports measuring the waist in the normal-BMI patient.
Opioid choice in GLP-1RA users: oxycodone was associated with more severe constipation and obstruction
When a GLP-1RA user needs an opioid, pair it with a laxative and warning signs; oxycodone was associated with the highest short-term risk.
FDA Class II recall: compounded semaglutide vials from Apollo Care contain particulate matter
Check the source of every patient's semaglutide; compounded vials from this firm are recalled for visible contaminants.
Tirzepatide and atrial fibrillation: no clear signal, but an arrhythmia composite edged above 1
No change to prescribing: tirzepatide has no clear atrial fibrillation signal, but ask about palpitations at follow-up.
SGLT2 inhibitors were not associated with gastrointestinal cancers across 48 trials
Trial data give no reason to avoid or stop an SGLT2 inhibitor for fear of gastrointestinal cancer.
Insulin sensitivity fell in the luteal phase, even on automated insulin delivery
When CGM shows a recurring week of worse control in a menstruating patient, ask about the cycle before changing settings.
Measure the waist the same way every time
Measure the waist at the rib–iliac midpoint after exhalation, and use 90 cm and 80 cm as South Asian thresholds.
Waist circumference identified diabetes better than BMI in adults of normal or overweight BMI
Measure the waist in adults with a normal or overweight BMI and test glucose when it is raised.
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