GLP-1 Agonist Use Increases the Incidence of Adhesive Capsulitis and Odds of Requiring Operative Management in Type 2 Diabetes Patients: A Matched Propensity Score Analysis.

Introduction: The incidence of adhesive capsulitis (AC) is higher in patients with diabetes mellitus. While AC is usually treated non-operatively, diabetic patients are more likely to require more extensive treatments such as manipulation under anesthesia (MUA) or arthroscopic capsular release. Despite the recent surge in popularity of GLP-1 agonists ("GLP-1s") for the treatment of type 2 diabetes (T2DM), there is a lack of literature describing the effect of GLP-1 use on the incidence and management of AC in patients with T2DM. We aimed to compare T2DM patients with and without GLP-1 use, and determine differences in rates of AC, rates of operative AC management, and rates of 90-day postoperative complications among operatively managed AC patients.
Methods: A retrospective cohort analysis of the PearlDiver database from 2010-2022 was performed to identify T2DM patients with AC. Exclusion criteria included patients <18 years old, type 1 diabetes, <2-year follow-up, and medical conditions that were a contraindication for GLP-1 use. Four cohorts were identified: 1) T2DM taking GLP-1s, 2) T2DM not taking GLP-1s, 3) T2DM with AC taking GLP-1s, and 4) T2DM with AC not taking GLP-1s. The primary outcome was the proportion of T2DM patients who developed AC. Secondary outcomes included rates of operative management and 90-day postoperative medical complications. A 1:1 propensity score match was performed, controlling for age, gender, Charlson Comorbidity Index, obesity, tobacco use, hypothyroidism, metformin use, insulin use, and the presence of complicated diabetes. Chi-square and Multivariable Linear Regression analyses were performed.
Results: 100,000 T2DM patients taking GLP-1s, and 100,000 T2DM patients not taking GLP-1s were randomly sampled. After matching, GLP-1 patients were more likely to develop AC (odds ratio [OR]=1.28, p<0.001). 253,717 T2DM patients with AC were then identified, of which, 46,156 (18.2%) were taking GLP-1s. After matching, GLP-1 users had higher odds of requiring operative management for AC compared to non-GLP-1 users (OR=1.18, p<0.001). The odds of undergoing MUA were significantly higher among GLP-1 users (OR=1.20, p<0.001), however, there was no difference in the odds of undergoing capsular release (OR=0.68, p=0.29).
Discussion: Among a national cohort of T2DM patients, patients taking GLP-1 agonists had higher odds of developing AC and requiring operative management for AC when compared to those not taking GLP-1s. These results can be useful when counseling T2DM patients who develop AC while taking GLP-1s to better inform these patients of the increased chance of requiring more extensive treatment.
(Copyright © 2025. Published by Elsevier Inc.)