As GLP-1 receptor agonists (RAs) and related weight-loss medications become ubiquitous in primary care, hospitalists are seeing an unmistakable shift in the kinds of patients who end up on their service: A September 2025 study found that starting a GLP-1 agent was associated with a lower overall risk for emergency department visits and hospitalizations, whereas an October 2025 analysis reported that patients with obesity or heart failure who were treated with semaglutide 2.4 mg had significantly lower medical costs and inpatient resource utilization vs those not treated.
These observations align with multiple cardiovascular-outcome trials and meta-analyses showing that GLP-1 RAs reduce major adverse cardiovascular events, helping to explain why some systems are now seeing fewer cardiovascular admissions among patients taking the drugs.
Additionally, a 2024 study in Nature Communications found individuals with moderate-to-advanced chronic kidney disease on a GLP-1 had lower annual rates of acute healthcare utilization and all-cause mortality, reinforcing the possibility that these drugs may actually reduce hospital burden in a wide range of metabolically vulnerable populations.
Not all findings point in the same direction, though. In patients with reduced ejection fraction heart failure, a 2023 meta-analysis showed an increased risk for heart-failure hospitalization among those receiving GLP-1 therapy. Additionally, an observational study in September 2023 reported no statistically significant reduction in all-cause death, heart-failure hospitalization, myocardial infarction, stroke, or composite cardiovascular outcomes among GLP-1 users.
Study authors on these projects and others indicate that these benefits may not extend uniformly across all subgroups. Other analyses, like this meta-analysis published on November 18, 2025, in the Journal of the American College of Cardiology, have documented increases in gastrointestinal (GI) disorders and gallbladder disease among GLP-1 users.
Taken together, this research and other data support the idea that GLP-1 therapy can meaningfully reduce certain kinds of hospitalizations — particularly cardiovascular-related events and acute metabolic crises — while leaving open important questions about whether it also increases inpatient care for complications like dehydration, gallbladder disease, gastroparesis, or perioperative risk.
The available studies do not directly document broad population-level shifts from cardiometabolic admissions to GI- or dehydration-related admissions, but early clinical signals, combined with the plausibility of medication-related adverse effects, suggest that such patterns are worth further investigation.
CV Improvements, Fewer Acute Events
Early signals point to meaningful reductions in hospitalizations for acute cardiometabolic events. Renato Apolito, MD, a cardiologist with Hackensack Meridian Health in Hackensack, New Jersey, said that outpatient improvements are key to understanding these shifts.
“I would take a step back from the hospitalizations because (that’s) a select population. You’re not going to see the people who avoided the hospital,” he said. “There’s no question, I think, we’ve all — those of us who have (prescribed) it — have seen only positive cardiovascular effects, which is consistent with the trial data.”
Manpreet Singh, MD, division chief of hospital medicine at Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, described a similar trend.
“In terms of reduced admissions, we’re seeing fewer hospitalizations among patients with established cardiovascular disease on GLP-1 RAs. We’re also seeing a significant decline in readmissions of obese patients,” he said. “Overall, we’ve realized decreased total inpatient costs and shorter length of stay.”
Singh said that his inpatient teams have not seen an uptick in the complications the studies highlighted.
Effects Requiring More Inpatient Monitoring
“As a result of nausea, vomiting, and diarrhea associated with these medications, there is risk of dehydration and renal failure,” Singh said.
Across the board, dehydration is the GLP-1-related problem cited by clinicians as the culprit that most often leads to emergency or inpatient evaluation.
Apolito said that most GI side effects that lead to dehydration can be managed with slower titration.
“In general, they’re not the most serious side effects,” he said. “A lot of times we just kind of go slow and low with the dosing because we don’t want to go up too quickly.”
Rapid weight loss can increase gallstone formation, and hospitalists have reported more cases of biliary colic and cholecystitis among GLP-1 users. Singh advised that primary care physicians watch for symptoms such as nausea, vomiting, loose stools, pain in the abdomen, jaundice, and fever while patients are on therapy with these medications.
Apolito recalled a rare but serious case involving pancreatitis in a patient with a prior history.
“I did see someone who was started on it (the GLP-1) by another doctor,” he said. “The patient had pancreatitis in the distant past, and they had a recurrence of the pancreatitis. That’s a no-no.”
Additionally, the use of GLP-1s may cause worsening of baseline gastroparesis, a problem for a significant number of patients with diabetes — a 2023 meta-analysis showed that the overall global prevalence of this issue among people with diabetes is roughly 9.3%.
“Diabetic patients who have gastroparesis can see an increase in their flare ups. Rarely, it can cause pancreatitis which is inflammation of the pancreas,” said Singh. “We have a general protocol for evaluation and triage of patients with nausea, vomiting, and diarrhea with consideration for GLP-1s if a patient was recently started on them.”
Vulnerable Populations, Avoidable Admissions
Certain groups appear at a higher risk for complications that may lead to hospitalization.
Older adults are at an increased risk for dehydration and electrolyte imbalance along with further increased risk for acute kidney injury, Singh said. Patients with a low baseline BMI are at an increased risk for malnutrition and higher risk for cholecystitis.
Several outpatient strategies can reduce the need for acute care associated with GLP-1 therapy. Apolito said slower titration may help patients who are sensitive to GI changes, and pausing the medication during severe symptoms or unrelated illness can prevent dehydration or kidney injury. Both clinicians said that reinforcing hydration is important at all times.
Apolito and Singh reported no disclosures.
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.