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Other significant considerations include: Injection site reactions (for subcutaneous formulations) Hypoglycaemia risk (particularly if used alongside other glucose-lowering medications) Pancreatitis (rare but serious) Gallbladder disease (including gallstones and cholecystitis) Dehydration leading to acute kidney injury (particularly with severe gastrointestinal side effects) Diabetic retinopathy complications (particularly noted with semaglutide in diabetes patients) Potential thyroid effects (medullary thyroid carcinoma risk in animal studies, though human relevance remains unclear) A Parkinson's-specific concern is that GLP-1 receptor agonists delay gastric emptying, which may further impair levodopa absorption and potentially worsen motor fluctuations or 'OFF' periods in patients on this medication

Views on how the impact of these treatments for obesity and diabetes could exceed those projected in our central scenario and the potential for further reductions in mortality and morbidity as the therapeutic landscape for incretin-based drugs expands beyond obesity and diabetes Considerations for how to incorporate these insights into future improvement bases Underwriting and claims considerations Key findings 1

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GLP-1 medications slow gastric emptying, which may slightly reduce how quickly you absorb levothyroxine