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IMPACT OF GLUCAGON-LIKE PEPTIDE-1 (GLP-1) RECEPTOR AGONISTS ON SUBSPECIALTY AND WEIGHT LOSS SURGERY REFERRALS
Thomas J. Mathews
*2, Richard Maradiaga
1, Thomas R. McCarty
3, Raj Shah
11The Ohio State University Wexner Medical Center, Columbus, OH; 2The University of Kansas Medical Center, Kansas City, KS; 3Houston Methodist Hospital, Houston, TX
Introduction:
The FDA-approval of glucagon-like peptide 1 (GLP-1) receptor agonists for weight loss has dramatically changed the landscape of obesity treatment. Given the shift towards pharmacologic treatment, it is unclear how this has impacted healthcare resources, particularly subspecialty clinic referral patterns and management decisions. We aimed to evaluate the impact of GLP-1 medications on surgical and medical subspecialty referrals, weight loss surgeries, and healthcare utilization among patients with obesity.
Methods:
This was a retrospective single-center study to investigate referral patterns and healthcare utilization, including emergency department (ED) visits and hospital admissions. Included study dates coincided with FDA approval of semaglutide (06/05/2021 through 06/04/2024) compared to pre-GLP-1 time period (06/05/2018 through 06/04/2021). Included patients were required to have an ICD-10 diagnosis of obesity with referrals to subspecialty clinics recorded, along with ED and hospital admissions. Additional referrals to bariatric surgery along with eventual bariatric surgery – sleeve gastrectomy and roux-en-Y gastric bypass was documented. Chi square testing was performed for statistical analyses.
Results:
Overall, the number of patients with the diagnosis of obesity increased from 2018-2021 (n=88,764) versus 2021-2024 (n=128,350). Endocrinology referrals decreased from 4.7% to 3.4% (P<0.0001) while gastroenterology referrals increased from 13% to 14% (P=0.003). Dietitian and nutrition referrals also decreased from 1.4% to 0.9% (P<0.0001) – Figure 1. Despite FDA approval of semaglutide, bariatric surgery referrals increased from 2.2% to 2.4% (p=0.0005), though the number of bariatric surgeries decreased overall. Stratifying by type of bariatric surgery revealed a decrease in sleeve gastrectomy (1.9% to 1.5%; P=0.001) though no change in roux-en-y gastric bypass (1.0% to 1.0%; P=0.790) – Figure 2. Rates of ED visits and hospital admission prior to GLP-1 agonists were similar compared to FDA approved era (both p>0.05).
Conclusion:
There was a significant increase in subspecialty referrals for patients with obesity to gastroenterology and bariatric surgery while referral to nutrition and endocrinology declined during the era of GLP-1 FDA approval. Although referrals to bariatric surgery clinic increased, rate of sleeve gastrectomy decreased significantly. Further studies on clinical practice are warranted to see if these trends continue as well as for healthcare systems to best accommodate this large shift in medical practices.
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