Metabolic surgery reduced death rates by one-third compared with glucagon-like peptide-1 receptor agonist medications in patients with type 2 diabetes and obesity, according to a large 10-year study published in Nature Medicine.

The study retrospectively analyzed 3,932 adults treated at the Cleveland Clinic Health System between 2010 and 2017. The cohort included 1,657 patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy and 2,275 patients treated with GLP-1 receptor agonists (RAs).

The median follow-up was 5.9 years. The primary endpoint was all-cause mortality, with major adverse cardiovascular events, nephropathy, and retinopathy assessed as secondary endpoints.

Surgery was associated with lower risks of death (9% vs 12%), major cardiovascular events (24% vs 34%), nephropathy (21% vs 37%), and retinopathy (6% vs 16%). At 10 years, mean body weight fell by 21% with surgery compared with 7% in the medical group, and hemoglobin A1c decreased by about 0.9% vs 0.2%.

Perioperative risks included serious complications in 7% of patients and a 90-day mortality of almost 0.5%.

“The present study can conclude that there are substantial additional benefits, including a survival benefit from metabolic surgery, in the era of GLP-1 RAs,” wrote lead study author Hamlet Gasoyan, PhD, of the Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio, and colleagues.

Full disclosures can be found in the published study.

Source: Nature Medicine