GLP-1’s drugs continue to expand horizons in gastroenterology, bariatrics, diabetes and chronic disease care — but the scale of the drugs’ adoption could be creating new areas of risk management for physicians, according to a report published Risk & Insurance April 29.
The first wave of concern relates to the proliferation of compounded medications and counterfeit products, according to the report. The FDA has raised concerns about unauthorized and improperly compounded GLP-1 formulations that may contain incorrect dosages or ingreidnets.
Adverse events have also been reported, according to the publication, especially as it relates to GLP-1s and anesthesia use. Because the drugs delay gastric emptying, a longer fasting period is required to mitigate risks of aspiration while under anesthesia — a risk that may go undetected if patients are not honest with their physicians about GLP-1 use.
Anne Marie Lyddy, senior risk management consultant at ProAssurance, told Risk & Insurance that the first red flag she encountered related to GLP-1 use was related to this risk.
“The first call I ever got — which was about two and a half years ago — was from an anesthesiologist in the Bay Area who had read an article that patients on GLP-1 medication experienced delayed gastric emptying which increased their risk of aspiration,” Ms. Lyddy said. “At that point, we hadn’t heard anything. That question was the first we’d heard. Now it’s very well known that this is an area of concern.”
In 2025 the Society for Perioperative Assessment and Quality Improvement released new guidelines advising patients using GLP-1 medications for weight loss to fast for a longer period of time preoperatively. In June 2023, the American Society of Anesthesiologists released initial guidelines for GLP-1 users, instructing them to hold usage of the medication leading up to procedures requiring anesthesia.
Aside from dosing errors, there may also be discrepancies in patient selection for these drugs as their use continues to expand.
“The explosion of online GLP-1 prescribing platforms has created an environment in which physicians may never physically see — or even speak with — their patients,” reads the report.
This creates potential for abuse and risk, especially among patients who may have a history of eating disorder or are otherwise prone to misusing appetite-suppressing medications.
“Physicians are certainly at risk. The companies that employ the physicians and create the opportunity for patients to sign up — the corporate entities behind the clinics — are also liable,” Ms. Lyddy said. “Compounding pharmacies are another group that could be on the hook. And who’s really monitoring them.”
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