A recent cohort study found that bariatric metabolic surgery reduces mortality by over 60% compared to GLP-1 receptor agonists in patients with obesity and diabetes of 10 years or less.
The cohort study, published in JAMA Network Open, compared bariatric metabolic surgery (BMS) with glucagon-like peptide-1 receptor agonists (GLP-1RAs) on mortality and major adverse cardiovascular events (MACEs) in patients with obesity and diabetes. The study included 6,070 patients from Clalit Health Services in Israel, with data from 2008 to 2021.
Among patients with a diabetes duration of 10 years or less, BMS was associated with a 62% reduction in mortality compared with GLP-1RAs (hazard ratio [HR], 0.38; 95% CI, 0.25-0.58). This reduction was mediated by weight loss (HR, 0.79; 95% CI, 0.43-1.48). No significant difference in mortality was observed for those with a diabetes duration longer than 10 years (HR, 0.65; 95% CI, 0.39-1.08). Additionally, there was no difference in the risk of MACEs between the two groups.
Patients had a mean age of 51 years, with 64.9% being women. Mortality rates were lower for BMS (266 per 100,000 person-years) compared to GLP-1RAs (785 per 100,000 person-years) in those with a shorter diabetes duration.
“Although the benefits associated with BMS and treatment with GLP-1RAs in reducing MACEs compared with standard of care have been well documented in recent years, a direct head-to-head prospective comparison between these two interventions has not been published, to our knowledge,” noted the researchers. “Our finding of a comparable association with nonfatal MACEs between the two treatments supports the hypothesis that the association of treatment with GLP-1RAs with the incidence of MACEs is independent of weight loss.”
The full list of disclosures can be found in the original study.