Highlight
• Oxycodone initiation in adults with type 2 diabetes (T2D) on GLP-1 receptor agonists (GLP-1RAs) is associated with higher short-term risks of severe constipation and bowel obstruction compared to hydrocodone and tramadol.
• Hydrocodone and tramadol show comparable gastrointestinal safety profiles in this patient population.
• No significant differences were observed in gastroparesis risk among the opioids studied.
• Careful opioid selection is crucial to minimize gastrointestinal adverse effects in T2D patients receiving GLP-1RA therapy.
