The edition · Diabetes & Endocrinology
With a GLP-1 agonist on board, oxycodone carries about half again the bowel risk of hydrocodone or tramadol
A 411,000-patient claims cohort puts numbers on an interaction most prescribers only suspect. Also: lifestyle treatment in PMOS pooled across 34 studies, waist beats BMI for spotting diabetes in 82 low- and middle-income countries, insulin sensitivity across the menstrual cycle on closed loop, and tirzepatide's arrhythmia signal.
The edition in brief
In a US claims cohort of 411,188 adults with type 2 diabetes using a GLP-1 receptor agonist, starting oxycodone was associated with a higher 30-day risk of severe constipation or bowel obstruction than starting hydrocodone (RR 1.48) or tramadol (RR 1.55); absolute risks were small, 0.51% against 0.33-0.35%. A meta-analysis of 34 studies in polyendocrine metabolic ovarian syndrome (PMOS, formerly PCOS) found lifestyle intervention associated with more regular cycles (OR 4.03) and modest falls in waist, fasting glucose and fasting insulin, with high heterogeneity. Across 598,883 adults with BMI 18.5-29.9 in 82 low- and middle-income countries, waist circumference and relative fat mass classified diabetes better than BMI (AUC 0.69 vs 0.63-0.64). An observational study of 77 people with type 1 diabetes on automated insulin delivery found insulin needs peaked and time in range fell in the luteal phase, with wide individual variation. A Bayesian meta-analysis of 10 tirzepatide trials found no clear association with atrial fibrillation (OR 2.20, CrI 0.81-6.75) but higher odds of any arrhythmia (OR 1.84, CrI 1.04-3.90) on low event counts.
Lifestyle treatment in PMOS: more regular cycles and modest metabolic gains, across 34 studies
Keep lifestyle intervention first-line in PMOS and let the woman choose the format; the benefit is real but modest and varies widely between programmes.
Waist circumference identified diabetes better than BMI in adults of normal to overweight BMI across 82 countries
Add a waist measurement to diabetes risk assessment in adults whose BMI looks reassuring, and test those with central adiposity.
On closed-loop insulin, needs rose and time in range fell in the luteal phase — but not for everyone
When time in range dips predictably each month in a menstruating patient on AID, check it against her cycle before changing the underlying settings.
Tirzepatide: no clear atrial fibrillation signal, but higher odds of any arrhythmia on few events
Keep prescribing tirzepatide where indicated, but ask about palpitations at follow-up; the trial data do not rule an arrhythmia effect in or out.
Ask about the bowels at every incretin review
Ask about constipation at every incretin review and look for other gut-slowing drugs on the list.
Patient on a GLP-1 agonist needs an opioid? Oxycodone carried the highest bowel risk
For a patient on a GLP-1 agonist who needs an opioid, avoid oxycodone where an alternative is suitable, and prescribe a laxative with whichever you choose.
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