Comparing Bariatric Metabolic Surgery, Glucagon-Like Peptide-1 Receptor Agonists Mortality Among Patients with Obesity and Diabetes

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Obesity is considered a chronic relapsing disease described by adiposopathy, pathogenic changes that can impact multiple systems of the body.¹ There is an existing association linking obesity with overall mortality, cardiovascular mortality, and a shorter life expectancy,² which draws greater attention to how valuable the of implementation of applicable interventions would be.

There are also studies demonstrating that a reduction in weight—alongside a decline in major cardiovascular events—has occurred among patients with or without type 2 diabetes when combined with glucagon-like peptide-1 receptor agonists (GLP-1RAs).

On their own, BMS and GLP-1RAs, presented their share of clinical advantages compared with conventional treatment, but at this point, it is not apparent as to how GLP-1RAs compare with BMS in reducing major adverse cardiovascular events (MACEs) and mortality. Therefore, in order solve this mystery, an observational, retrospective cohort study published in JAMA Network Open³ sought to determine exactly that.

The study pulled data from the electronic medical records of Clalit Health Services (Clalit), a healthcare organization in Israel. It featured 6,070 patients aged 24 years or older—during the timeframe between Jan. 1, 2008 and Dec. 31, 2021—who were reported to have diabetes and obesity, with no prior history of congestive heart failure, ischemic stroke, or ischemic heart disease. Patients were to have undergone BMS and received GLP-1RAs during the aforementioned timeframe, were classified according to age, sex, and clinical characteristics. They were matched 1:1 (representing one patient who underwent BMS to one patient treated with GLP-1RAs).

In all, there were 3,035 matched pairs of patients (total, 6,070; mean [standard deviation, SD] age, 51.0 [9.5] years; 3,938 women [64.9%]), who were followed up with for a median of 6.8 years (interquartile range, IQR, 4.1-9.4 years). For patients with a diabetes duration of 10 years or less (2,371 pairs), mortality was considered lower for individuals who underwent BMS than for those treated with GLP-1RAs (hazard ratio [HR], 0.38; 95% confidence interval, CI, 0.25-0.58).

However, results indicated that this association soon turned out to be “nonsignificant,” once weight loss was included in the model during the follow-up time (HR, 0.79; 95% CI, 0.43-1.48). Amongst patients who have had diabetes for longer than 10 years (664 pairs), there was no survival advantage for BMS over GLP-1RA (HR, 0.65; 95% CI, 0.39-1.08). There was also no difference in risk for nonfatal MACEs between the treatment groups (HR, 0.74; 95% CI, 0.49-1.10 among patients with a diabetes duration of ≤10 years; HR, 1.21; 95% CI, 0.80-1.85 among patients with a diabetes duration of >10 years).

As a result, the investigators concluded that, “This retrospective cohort study found that, among individuals with a diabetes duration of 10 years or less and without a prior history of CVD or congestive heart failure, BMS was associated with lower all-cause mortality compared with GLP-1RA treatment, over a median follow-up of 6.8 years. Weight reduction was identified as a mediating factor in this association. No difference between BMS and treatment with GLP-1RAs was observed in the risk of mortality among individuals with a longer duration of diabetes (>10 years), nor in the risk of MACEs among all patients.”

References

1. Perdomo CM, Avilés-Olmos I, Dicker D, Frühbeck G. Towards an adiposity-related disease framework for the diagnosis and management of obesities. Rev Endocr Metab Disord. 2023;24(5):795-807. doi:10.1007/s11154-023-09797-2PubMedCrossref

2. Bhaskaran K, Dos-Santos-Silva I, Leon DA, Douglas IJ, Smeeth L. Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3.6 million adults in the UK.Lancet Diabetes Endocrinol. 2018;6(12):944-953. doi:10.1016/S2213-8587(18)30288-2

3. Dicker D, Sagy YW, Ramot N, et al. Bariatric Metabolic Surgery vs Glucagon-Like Peptide-1 Receptor Agonists and Mortality. JAMA Netw Open. 2024;7(6):e2415392. doi:10.1001/jamanetworkopen.2024.15392