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However, conflicting evidence highlights context-dependent risks, such as early DR worsening in poorly controlled glycemic states

Neuroscience 180 : 111121

These complications are more common in patients who already have some diabetic retinopathy when they begin GLP-1 therapy

FDA-labeled warnings include: Risk of thyroid C-cell tumors (contraindicated in patients with personal/family history of medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2) Pancreatitis (report severe abdominal pain, with or without vomiting) Gallbladder disease (including gallstones and cholecystitis) Acute kidney injury secondary to dehydration from gastrointestinal symptoms Hypoglycemia when used with insulin or insulin secretagogues (dose adjustments may be needed) Diabetic retinopathy complications in patients with type 2 diabetes and pre-existing retinopathy Suicidal behavior and ideation (monitor for depression or suicidal thoughts) Intestinal obstruction/ileus (particularly with severe constipation) These medications are contraindicated during pregnancy and should be discontinued at least two months before a planned pregnancy