Fasting duration and GLP-1 RA temporary withholding effects on gastric contents investigated with liraglutide and semaglutide
Background
GLP-1 receptor agonists (GLP-1 RAs) are widely used for obesity and type 2 diabetes, primarily by enhancing insulin secretion and slowing gastric emptying. This delayed gastric emptying poses a significant concern for patients requiring surgery, as it increases the risk of aspiration during anesthesia, even after standard fasting periods. Current preoperative fasting guidelines may not adequately account for the prolonged gastric residence time induced by GLP-1 RAs. This study aims to clarify optimal fasting durations and the impact of temporary GLP-1 RA cessation on gastric contents.
Study Design
This Phase 1, non-randomized study will enroll an estimated 75 participants already on liraglutide (subcutaneous), oral semaglutide, or subcutaneous semaglutide. Participants will undergo fasting periods of varying durations (6, 8, 10, 12, 18, and 24 hours) after consuming a solid, high-fat meal. The primary endpoint is the occurrence of an empty stomach, defined as antrum grade 0 or 1, measured at specified timeframes after fasting initiation. The study will also investigate the effect of temporarily withholding GLP-1 RAs.
Why It Matters
This study is critically important for enhancing patient safety during surgical procedures for individuals using GLP-1 RAs. The findings will directly inform updated preoperative fasting guidelines, potentially preventing serious complications like pulmonary aspiration. Currently, there's a lack of clear, evidence-based protocols for managing GLP-1 RA users before anesthesia, leading to uncertainty and potential delays. Understanding the precise duration GLP-1 RAs affect gastric emptying, and how temporary cessation impacts this, will allow clinicians to implement safer, more tailored fasting regimens. This research is a vital step towards optimizing perioperative care for a growing patient population.
liraglutide
semaglutide
glp-1-agonist
obesity
gastric-emptying
fasting