GLP-1 receptor agonists were associated with increased incident chronic cough among adults with type 2 diabetes, in US EHR records.
Why GLP-1 Use Was Examined for Cough
GLP-1 receptor agonists have expanded rapidly in clinical practice for type 2 diabetes and obesity management. While these agents have been linked to gastroesophageal reflux disease and may influence vagal pathways, the clinical association between GLP-1 receptor agonists and chronic cough has not been well characterized. Investigators therefore evaluated whether patients prescribed GLP-1 receptor agonists experienced a higher risk of new chronic cough compared with other commonly used second line diabetes therapies.
GLP-1 Receptor Agonists and Chronic Cough Risk
This large multicenter cohort study analyzed electronic medical record data from 70 US health care organizations spanning April 28, 2005, to April 15, 2025. Adults aged 18 years or older with type 2 diabetes who were prescribed a GLP-1 receptor agonist were compared with matched adults prescribed other second line medications, including DPP-4 inhibitors, SGLT2 inhibitors, and sulfonylureas. After propensity score matching and Cox regression adjustment, GLP-1 receptor agonists were linked to a higher risk of new chronic cough versus any non GLP-1 second line therapy, with an adjusted hazard ratio of 1.12.
When examined by comparator class, the association remained significant versus DPP-4 inhibitors and sulfonylureas, but not versus SGLT2 inhibitors in the primary matched analysis. To explore whether reflux could explain the signal, the authors repeated analyses after removing patients with prior gastroesophageal reflux disease. In that reflux excluded subgroup, GLP-1 receptor agonists were again associated with increased chronic cough risk, including versus SGLT2 inhibitors.
Clinical Takeaways for Practice
These findings support considering chronic cough as a potential adverse event signal during GLP-1 receptor agonist therapy, even when reflux is not documented. The results do not establish causality, but they suggest clinicians may wish to ask about new, persistent cough after initiation and to evaluate alternative explanations while weighing diabetes and weight management goals against symptom burden.
Reference: Gallagher TJ et al. Glucagon-Like Peptide-1 Receptor Agonists and Chronic Cough. JAMA Otolaryngol Head Neck Surg. 2025;doi: 10.1001/jamaoto.2025.4181.
