Chronic constipation is more common in diabetes patients than the general population, and GLP-1 receptor agonist peptide drugs — increasingly prescribed for blood sugar and weight management — are an additional cause of this underrecognized problem.
More prevalent in diabetesChronic constipation occurs more frequently in people with diabetes than in healthy individuals, with GLP-1 peptide drugs adding to the risk
What the researchers found
Constipation in diabetes has a multifactorial etiology involving structural changes in gastrointestinal tract wall tissues and functional abnormalities secondary to chronic hyperglycemia. GLP-1 receptor agonists — peptide-based medications critical for glycemic control and cardiovascular/renal risk reduction in type 2 diabetes — are identified as an additional cause of constipation.
Diagnosis is typically clinical, as validated methods for assessing colonic transit are invasive and limited to specialized centers. Treatment follows a stepwise approach: dietary modification and physical activity first, followed by laxatives, and finally newer agents or mechanical methods for refractory cases.
Why it matters
GLP-1 receptor agonists are among the fastest-growing drug classes worldwide, with tens of millions of prescriptions annually for diabetes and obesity. As these peptide drugs become standard of care, their gastrointestinal side effects — particularly constipation — deserve more clinical attention. Understanding that constipation in diabetic patients may be disease-related, drug-related, or both is essential for proper management and quality of life.
How the study worked
This is a narrative review of literature published up to May 30, 2025, focusing on the pathogenesis of constipation in diabetes mellitus, the correlation with GLP-1 receptor agonist treatment, and the diagnostic-therapeutic framework.
What this study cannot tell us
As a narrative review, it may not capture all relevant literature systematically. The abstract does not provide prevalence estimates for constipation in GLP-1 RA users specifically. The multifactorial nature of constipation in diabetes makes it difficult to attribute causation to any single factor. The review does not compare constipation rates across different GLP-1 agonists or doses.
How to read the evidence
This is a narrative review synthesizing existing literature on a clinical problem. It provides a useful clinical overview but does not present new data, perform a systematic search, or conduct a meta-analysis.
When this study was published
Published in 2025 with literature reviewed through May 2025, this review is current and reflects the latest understanding of GLP-1 agonist side effects during a period of rapid growth in their clinical use.
The bigger picture
This review highlights an important quality-of-life issue that accompanies the GLP-1 agonist revolution. While these peptide drugs offer remarkable benefits for metabolic and cardiovascular health, their gastrointestinal side effects — including constipation, nausea, and slowed gastric emptying — are a frequent reason patients discontinue treatment. Better understanding and management of these side effects could improve adherence and overall outcomes for the growing population taking GLP-1-based therapies.
Questions still open
- Do different GLP-1 receptor agonists (semaglutide, liraglutide, tirzepatide) cause constipation at different rates?
- Can proactive management strategies at the time of GLP-1 agonist initiation prevent constipation from developing?
- Does GLP-1 agonist-induced constipation improve with continued use, or does it persist throughout treatment?
Common questions
Can GLP-1 drugs like semaglutide cause constipation?
What should I do if I get constipated while taking a GLP-1 agonist?
Read the original research
The Sweet Side of Constipation: Colonic Motor Dysfunction in Diabetes Mellitus.
Nutrients, 17(19)
Citation
De Fano, Michelantonio; Baluganti, Sara; Manco, Marcello; Porcellati, Francesca; Fanelli, Carmine G; Bassotti, Gabrio. (2025). The Sweet Side of Constipation: Colonic Motor Dysfunction in Diabetes Mellitus.. Nutrients, 17(19). https://doi.org/10.3390/nu17193038