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2022 JAMA Internal Medicine meta-analysis: pooling 76 randomised controlled trials, GLP-1 receptor agonist use was associated with a relative risk of 1.37 for biliary disease compared with placebo or other treatments

The risks include: Ineffective blood sugar control

Metformin treatment significantly enhances intestinal glucose uptake in patients with type 2 diabetes: results from a randomized clinical trial

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However, these mechanisms may relate to a combination of effects on weight, blood pressure, glucose and lipid levels, inflammation, and potential effects on other factors promoting atherothrombosis [5]