Metabolic Surgery in the Era of GLP-1 Receptor Agonists

Clinical Takeaway

: Among patients with diabetes and obesity, metabolic surgery was associated with fewer deaths at 10 years than were GLP-1 agonists.

Context

Both metabolic surgery and glucagon-like peptide-1 (GLP-1) receptor agonists are associated with improved cardiovascular outcomes in obese patients with diabetes, but direct comparisons are lacking. In this observational study of patients with diabetes and obesity, 1700 patients who underwent Roux-en-Y gastric bypass or sleeve gastrectomy were compared with 2300 patients who received GLP-1 agonists between 2010 and 2017. At baseline, mean ages were 51 and 57 in the surgery and drug-treatment groups; mean body–mass indexes were 46 and 39 kg/m²; analyses were adjusted for these and other differences.

Key Results

At 10 years, mortality was lower with surgery than with GLP-1 agonists (9% vs. 12%).
Major adverse cardiovascular events occurre…

Reviewing Authors

Jeffrey Kohlwes, M.D., M.P.H.

Guest Author

Dr. Kohlwes is the Division Chief of General Internal Medicine for the San Francisco VA Health Care System and Codirector of the PRIME Residency Program at the University of California San Francisco.