American Board of Internal Medicine (ABIM) Certification Practice Exam

Which adverse effect is associated with the use of glucagon-like peptide (GLP-1) analogues in diabetes treatment?

1. Increased risk of gastritis

2. Cholestasis and cholelithiasis

3. Hypoglycemia

4. Weight gain

The correct answer is: Cholestasis and cholelithiasis

The use of glucagon-like peptide (GLP-1) analogues in diabetes treatment is commonly associated with several adverse effects, with cholestasis and cholelithiasis being notable considerations. GLP-1 analogues work by enhancing glucose-dependent insulin secretion, decreasing glucagon secretion, and slowing gastric emptying, all of which contribute to better glycemic control. However, these mechanisms can influence gallbladder motility and bile secretion, leading to an increased risk of developing gallstones (cholelithiasis) as well as potential cholestasis due to impaired bile flow. While hypoglycemia can occur with many diabetes medications, GLP-1 analogues are less likely to cause this adverse effect when used alone because they primarily act in a glucose-dependent manner. Weight gain can be a concern with certain diabetes treatments, but GLP-1 analogues are typically associated with weight loss due to reduced appetite and slower gastric emptying. Gastritis is not a well-documented adverse effect of GLP-1 treatment, making cholestasis and cholelithiasis the more relevant concern in this context.