Cardiovascular and diabetes outcomes among patients with obesity and type 2 diabetes after metabolic bariatric surgery or glucagon-like peptide 1 receptor agonist treatment

Sep 5, 2024The British journal of surgery

Heart and diabetes results in obese patients with type 2 diabetes after weight-loss surgery or medication treatment

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Abstract

Over a mean follow-up of 7 years, 14.5% of patients who underwent experienced compared to 19.6% of those treated with .

Patients in the surgery group had lower average haemoglobin A1c values five years after treatment.
Surgery was associated with fewer microvascular complications, including retinopathy, nephropathy, and neuropathy or leg ulcers.
However, the surgery group showed an increased risk of alcohol or substance abuse, self-harm, and fractures compared to the glucagon-like peptide 1 receptor agonist group.

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BACKGROUND: With the increasing prevalence of obesity and type 2 diabetes, the availability of different treatment options remains essential. Studies comparing the outcomes of with those of in patients with type 2 diabetes and obesity are lacking.

METHODS: Using propensity score matching, based on data from several nationwide clinical registries, patients who underwent primary metabolic bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) were matched with patients who received glucagon-like peptide 1 receptor agonists. Outcome measures included the occurrence of , microvascular complications, and potential side effects (alcohol/substance abuse, self-harm, and fractures).

RESULTS: Over a mean follow-up of 7 years, major cardiovascular events occurred in 191 of 2039 patients (cumulative incidence 14.5%) in the surgery group compared with 247 of 2039 patients (19.6%) in the glucagon-like peptide 1 receptor agonist group (HR 0.75 (95% c.i. 0.62 to 0.91), P = 0.003). Patients in the surgery group had lower haemoglobin A1c values 5 years after treatment (mean difference 9.82 (95% c.i. 8.51 to 11.14) mmol/mol, P < 0.001) and fewer microvascular complications (retinopathy HR 0.88 (95% c.i. 0.79 to 0.99), P = 0.039; nephropathy HR 0.72 (95% c.i. 0.66 to 0.80), P < 0.001; and neuropathy or leg ulcers HR 0.82 (95% c.i. 0.74 to 0.92), P < 0.001), but a higher risk of alcohol/substance abuse (HR 2.56 (95% c.i. 1.87 to 3.50), P < 0.001), self-harm (HR 1.41 (95% c.i. 1.17 to 1.71), P < 0.001), and fractures (HR 1.86 (95% c.i. 1.11 to 3.12), P = 0.019).

CONCLUSION: Compared with glucagon-like peptide 1 receptor agonist treatment, metabolic bariatric surgery is associated with superior metabolic outcomes and a lower risk of major cardiovascular events in patients with type 2 diabetes and obesity, but a higher risk of alcohol/substance abuse, self-harm, and fractures.

Key numbers

14.5%

Cumulative Incidence of

191 of 2039 patients in the surgery group experienced .

9.82 mmol/mol

Mean Difference in Hemoglobin A1c

Patients in the surgery group had lower HbA1c values compared to the group.

2.56×

Increased Risk of Alcohol/Substance Abuse

Patients in the surgery group had a higher hazard ratio for alcohol/substance abuse.

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Cardiovascular and diabetes outcomes among patients with obesity and type 2 diabetes after metabolic bariatric surgery or glucagon-like peptide 1 receptor agonist treatment

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