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14, 2025 The Lancet Diabetes & Endocrinology, Sept

High-risk features at baseline: Prior symptomatic gallstones or biliary colic Existing asymptomatic stones on prior imaging Obesity (BMI 35), particularly in female patients over 40 Rapid prior weight loss history Crohn's disease or terminal ileal resection (impairs bile salt reabsorption) Family history of cholelithiasis Patients with prior symptomatic gallstones should discuss prophylactic cholecystectomy with a surgeon before starting semaglutide, or at minimum have a baseline ultrasound documented in the chart

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The nucleus tractus solitarius (NTS) contains GLP-1 neurons that are activated by nicotine