New research has revealed that GLP-1 receptor agonists may significantly benefit patients with celiac disease, particularly in reducing the risk of iron deficiency anemia and improving survival rates. The findings were presented by Jonathan Ghobrial, MD, an internal medicine resident at Allegheny Health Network Medicine Institute, during the American College of Gastroenterology (ACG) Annual Scientific Meeting in October 2025. This study could have important implications for addressing nutritional deficiencies in a patient population that experiences malabsorption issues.
GLP-1 receptor agonists, commonly used in the treatment of type 2 diabetes and obesity, have gained traction across various medical fields as their indications expand to include conditions like chronic kidney disease and metabolic dysfunction-associated steatohepatitis. With the rising use of these medications, research has begun to explore their effects on gastrointestinal function and nutrient absorption.
Ghobrial and his colleagues noted, “Their impact on nutritional deficiencies and clinical outcomes in patients with celiac disease has not been well characterized.” This research is pioneering in evaluating the relationship between GLP-1 agonist use and critical clinical outcomes, including anemia, transfusions, hospitalization, and mortality, within a substantial cohort of celiac patients.
For this study, researchers utilized data from TriNetX, identifying patients diagnosed with celiac disease through ICD-10 codes. They categorized these patients based on their exposure to GLP-1 agonists, including semaglutide, dulaglutide, liraglutide, or exenatide. A 1:1 propensity score matching was applied, considering demographics, comorbidities, and relevant laboratory values to ensure a balanced comparison.
Outcomes of interest encompassed mortality rates, occurrences of iron deficiency anemia, transfusion requirements, B12 and folate deficiencies, gastrointestinal bleeding, and hemoglobin trends. In total, the analysis included 18,582 matched patients, with 9,291 in each group.
The results indicated that patients using GLP-1 agonists experienced significantly lower mortality rates—1.9% compared to 3.3%—with a hazard ratio of 1.82 (95% CI, 1.51–2.20; P < .001). Additionally, these patients required fewer transfusions, with rates of 0.9% versus 1.3% (HR, 1.50; P = .004). The risk of iron deficiency anemia was notably higher among non-GLP-1 users at 6.5% compared to 5.4% in the GLP-1 group (HR, 1.26; P = .001).
Further analysis also uncovered a reduced risk of B12 or folate deficiency in GLP-1 users, with rates of 0.8% versus 1.3% (HR, 1.62; P = .001). While rates of gastrointestinal bleeding were slightly elevated in the GLP-1 group according to time-to-event analysis (HR, 1.21; P = .044), the researchers emphasized that the absolute risk was comparable between the groups.
The findings highlight a potential strategy for mitigating nutritional deficiencies, particularly iron deficiency anemia, in a population at risk due to malabsorption issues. “Although by what means GLP-1 agonists confer a reduced risk of iron deficiency anemia in celiac patients is not understood from this study, further studies are warranted to evaluate these findings,” the researchers concluded.
As awareness of the implications of GLP-1 receptor agonists grows, this research paves the way for deeper investigations into their role in the management of celiac disease and associated nutritional challenges.
