Park HJ, Oh YE, Chi SA, Kim M, Kim JE, Hong SN, Min BH, Kim YH, Chang DK, Kim TS, Kim ER. Impact of glucagon-like peptide-1 receptor agonists on bowel preparation quality for colonoscopy in type 2 diabetes. World J Gastroenterol 2026; 32(46): 121313 [DOI: 10.3748/wjg.121313]
Corresponding Author of This Article
Eun Ran Kim, MD, PhD, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea. er.kim@samsung.com
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Gastroenterology & Hepatology
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research-article
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Park HJ, Oh YE, Chi SA, Kim M, Kim JE, Hong SN, Min BH, Kim YH, Chang DK, Kim TS, Kim ER. Impact of glucagon-like peptide-1 receptor agonists on bowel preparation quality for colonoscopy in type 2 diabetes. World J Gastroenterol 2026; 32(46): 121313 [DOI: 10.3748/wjg.121313]
World J Gastroenterol. Dec 14, 2026; 32(46): 121313 Published online Dec 14, 2026. doi: 10.3748/wjg.121313
Impact of glucagon-like peptide-1 receptor agonists on bowel preparation quality for colonoscopy in type 2 diabetes
Hyun Jung Park, Young Eun Oh, Sang Ah Chi, Minjee Kim, Ji Eun Kim, Sung Noh Hong, Byung-Hoon Min, Young-Ho Kim, Dong Kyung Chang, Tae-Se Kim, Eun Ran Kim
Hyun Jung Park, Young Eun Oh, Minjee Kim, Ji Eun Kim, Sung Noh Hong, Byung-Hoon Min, Young-Ho Kim, Dong Kyung Chang, Tae-Se Kim, Eun Ran Kim, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Sang Ah Chi, Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, South Korea
Co-first authors: Hyun Jung Park and Young Eun Oh.
Co-corresponding authors: Tae-Se Kim and Eun Ran Kim.
Author contributions: Park HJ and Oh YE contributed equally to this work and are co-first authors; Park HJ and Oh YE drafted the manuscript; Park HJ, Oh YE, Kim TS, and Kim ER contributed to the conception and design of the study; Park HJ, Oh YE, Chi SA, Kim TS, and Kim ER contributed to the analysis and interpretation of the data; Kim M, Kim JE, Hong SN, Min BH, Kim YH, and Chang DK contributed to data acquisition and critically revised the manuscript for important intellectual content; Kim TS and Kim ER contributed equally as co-corresponding authors. All authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work.
AI contribution statement: No AI tools were used in a manner that requires disclosure under the AI tool usage policy.
Institutional review board statement: This study was approved by the Institutional Review Board of Samsung Medical Center, No. 2025-02-025.
Informed consent statement: The requirement for written informed consent was waived by the Institutional Review Board given the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Corresponding author: Eun Ran Kim, MD, PhD, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea. er.kim@samsung.com
Received: April 7, 2026 Revised: June 11, 2026 Accepted: June 30, 2026 Published online: December 14, 2026 Processing time: 198 Days and 15.6 Hours
Abstract
BACKGROUND
Adequate bowel preparation is essential for high-quality colonoscopy because it directly affects mucosal visualization, adenoma detection, completion rate, and the need for repeat procedures. Patients with type 2 diabetes mellitus (T2DM) have a higher risk of inadequate bowel cleansing than the general population, partly because of delayed gastrointestinal motility and associated comorbidities. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are increasingly being prescribed for T2DM, but they can delay gastrointestinal transit, and potentially impair bowel preparation. However, clinical data on the effects of GLP-1RAs on bowel cleansing are limited.
AIM
To evaluate the association between GLP-1RA use and bowel preparation quality in patients with T2DM undergoing colonoscopy.
METHODS
We conducted a retrospective cohort study of patients with T2DM undergoing colonoscopy at a tertiary referral hospital in South Korea. After propensity score matching, we compared 133 patients receiving GLP-1RAs with 208 patients receiving dipeptidyl peptidase-4 inhibitors as an active comparator. The primary outcome was inadequate bowel preparation (IBP), defined as a total Boston Bowel Preparation Scale score < 6 or any segmental score < 2. Segment-specific bowel preparation quality, including right-colon cleansing, was also assessed.
RESULTS
IBP was more frequent in the GLP-1RA group than in the dipeptidyl peptidase-4 inhibitors group (25.6% vs 15.4%, P = 0.034). Right-colon IBP was also higher in the GLP-1RA group (24.1% vs 13.5%, P = 0.013) and mean right-colon Boston Bowel Preparation Scale score was consistently lower (1.9 ± 0.8 vs 2.1 ± 0.7, P = 0.031). In multivariable analysis, GLP-1RA use (adjusted odds ratio = 1.89; 95% confidence interval: 1.05-3.39, P = 0.034) and male sex (adjusted odds ratio = 2.46; 95% confidence interval: 1.24-4.89, P = 0.010) were identified as independent risk factors for IBP.
CONCLUSION
GLP-1RA use was associated with IBP in patients with T2DM, particularly in the right colon. Optimized bowel preparation protocols should be considered before colonoscopy in patients receiving GLP-1RAs.
Core Tip: Glucagon-like peptide-1 receptor agonists are increasingly used in patients with type 2 diabetes mellitus; however, their effect on bowel preparation quality before colonoscopy remains unclear. In this propensity score-matched cohort study, glucagon-like peptide-1 receptor agonist use was associated with a high risk of inadequate bowel preparation, particularly in the right colon. These findings highlight a practical issue in endoscopic practice and suggest that optimized bowel preparation strategies should be considered for patients receiving these agents.
