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JAMA surgery···
Use of Diabetes-Related Weight-Loss Drugs in People Having Weight-Loss Surgery in the US
Updated
Abstract
Among 112,858 individuals undergoing bariatric surgery, 14.0% initiated GLP-1s after surgery.
- The mean age of participants was 45.2 years, with 78.9% being female.
- By self-reported race, 64.2% were White, 22.1% were Black or African American, and 1.1% were Asian.
- Initiation of GLP-1s occurred primarily within 2 years post-surgery for 21.5% of those who began treatment.
- Female patients, those who underwent sleeve gastrectomy, and individuals with type 2 diabetes had higher initiation rates.
- Each 1-unit increase in postsurgical BMI was associated with an 8% increase in the likelihood of GLP-1 initiation.
Simplified
IMPORTANCE: Although randomized and well-controlled observational studies demonstrate the efficacy of glucagon-like peptide-1 receptor agonists (GLP-1s) for weight management after bariatric surgery, little is known regarding the frequency and predictors of such use.
OBJECTIVE: To characterize the use of and factors associated with GLP-1 initiation among US adults undergoing bariatric surgery.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was conducted using a national multicenter database of electronic health records of approximately 113 million US adults. Adults undergoing bariatric surgery from January 2015 to May 2023 who did not use GLP-1s during the 12 months prior to surgery were eligible for inclusion. Data were analyzed from October 2024 to May 2025.
EXPOSURES: Sociodemographic factors (age, sex, race, region, etc) and clinical factors (bariatric surgery procedures, body mass index [BMI, calculated as weight in kilograms divided by height in meters squared], comorbidities, comedications).
MAIN OUTCOMES AND MEASURES: The primary outcome was GLP-1 initiation after bariatric surgery, first characterized using descriptive statistics. Cox proportional hazards models were then used to identify baseline patient characteristics associated with GLP-1 initiation. Time-dependent Cox models were also used to examine the association of postsurgery BMI with GLP-1 initiation.
RESULTS: Among 112 858 individuals undergoing bariatric surgery, mean (SD) age was 45.2 (12.9) years, and 88 994 individuals (78.9%) were female. By self-reported race, 1210 individuals (1.1%) were Asian, 24 941 (22.1%) were Black or African American, 72 423 (64.2%) were White, and 14 284 (12.6%) reported other race (American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, or unknown). A total of 15 749 individuals (14.0%) initiated GLP-1s after surgery, with 3391 (21.5%) beginning within 2 years of surgery and the remainder initiating during postsurgical years 3 to 4 (5082 [32.3%]), years 5 to 6 (3964 [25.2%]), or beyond (3312 [21.0%]). The overall median (IQR) BMI before GLP-1 initiation was 42.0 (38.3-45.6). In regression models, female patients (adjusted hazard ratio [aHR], 1.61; 95% CI, 1.54-1.69), those undergoing sleeve gastrectomy (aHR, 1.42; 95% CI, 1.37-1.47), and those with type 2 diabetes (aHR, 1.34; 95% CI, 1.28-1.39) were more likely to initiate GLP-1s than their counterparts. Each 1-unit increase in postsurgical BMI was associated with an 8% increase in likelihood of GLP-1 initiation (aHR, 1.08; 95% CI, 1.08-1.08).
CONCLUSIONS AND RELEVANCE: In this retrospective cohort study using a nationwide database, among a cohort of US adults undergoing bariatric surgery, approximately 1 in 10 initiated a GLP-1. Initiation was greater among women, those undergoing sleeve gastrectomy, and individuals with larger BMI regain than among their counterparts.
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