Is there an association between Glucagon-like peptide-1 (GLP-1) inhibitors and an increased risk of infections?

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Association Between GLP-1 Receptor Agonists and Infections

GLP-1 receptor agonists are associated with an increased risk of genitourinary infections, particularly urinary tract infections, but do not significantly increase the risk of other types of infections. 1, 2

Infection Risk Profile of GLP-1 Receptor Agonists

Genitourinary Infections

  • GLP-1 receptor agonists have been associated with a small increase in urinary tract infections 1
  • This risk appears to be lower than that observed with SGLT2 inhibitors, which are known to cause a higher rate of genital mycotic infections, especially in women 1

Respiratory and Other Infections

  • Recent comprehensive analysis of health outcomes in patients using GLP-1RAs showed a reduced risk of various infectious illnesses compared to usual care 2
  • No significant increase in risk of respiratory infections has been documented in major guidelines or studies 1, 2

Comparison with Other Diabetes Medications

SGLT2 Inhibitors

  • SGLT2 inhibitors carry a significantly higher risk of genitourinary infections than GLP-1RAs 1
  • Common adverse effects of SGLT2 inhibitors include:
    • Genital mycotic infections (particularly in women)
    • Urinary tract infections
    • Increased risk of infection-triggered euglycemic diabetic ketoacidosis 1

DPP-4 Inhibitors

  • DPP-4 inhibitors have not shown significant association with increased infection risk 3
  • Generally well-tolerated with neutral effect on infection rates

Clinical Considerations

Patient Monitoring

  • Regular monitoring for signs of urinary tract infections is recommended for patients on GLP-1RAs
  • Patients should be educated about symptoms of UTIs and when to seek medical attention
  • No special infection prevention protocols are required specifically for GLP-1RA therapy

Risk Factors for Infection

  • Patients with a history of recurrent UTIs may need closer monitoring
  • Those with compromised immune function may require additional consideration when prescribing GLP-1RAs

Recent Evidence on Broader Infection Risk

A large-scale 2025 study using US Department of Veterans Affairs databases (n=215,970 GLP-1RA users) found that GLP-1RA use was actually associated with a reduced risk of infectious illnesses compared to usual care 2. This suggests that the overall infection risk profile of these medications may be favorable despite the small increase in urinary tract infections.

Practical Recommendations

  • When initiating GLP-1RA therapy, counsel patients about the small increased risk of urinary tract infections
  • No need to avoid GLP-1RAs in patients with prior history of infections unless specifically contraindicated
  • Monitor for signs and symptoms of UTIs, particularly in at-risk populations
  • Consider the overall favorable risk-benefit profile of GLP-1RAs, including their beneficial effects on glycemic control, weight management, and cardiovascular outcomes 1

In summary, while GLP-1 receptor agonists are associated with a small increased risk of urinary tract infections, they do not significantly increase the risk of other types of infections and may even be associated with reduced risk of certain infectious illnesses compared to other diabetes treatments.

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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