Metabolic Surgery Shows Superiority to GLP-1 Agonists in Long-Term Outcomes for Diabetes and Obesity, Landmark Study Reveals
LONDON – In a perhaps practice-changing finding, metabolic surgery demonstrated substantially greater benefits than glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in mitigating both macrovascular and microvascular complications among patients with diabetes and obesity, according to research published today in The Lancet. The multi-national, randomized controlled trial-the largest of its kind-followed participants for up to ten years, challenging conventional treatment paradigms and offering a new avenue for managing these increasingly prevalent conditions.
The study, involving 3,041 adults with type 2 diabetes and obesity, provides compelling evidence that bariatric surgery isn’t solely a weight-loss intervention, but a powerful tool for reducing the long-term health risks associated with metabolic disease. With diabetes and obesity rates continuing to climb globally, impacting hundreds of millions and straining healthcare systems, the findings underscore the need to reassess treatment strategies and consider metabolic surgery as a viable option for a broader patient population. the research team anticipates these results will fuel further discussion regarding access to, and coverage of, metabolic surgery as a preventative measure against debilitating and life-threatening complications.
Researchers, led by Dr.Simon Heller at the University of Sheffield, randomly assigned participants to either metabolic surgery (various procedures including gastric bypass and sleeve gastrectomy) or guideline-based medical therapy with GLP-1 RAs. The primary outcome was the first occurrence of a major adverse cardiovascular event (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke.
Over a median follow-up of 5.8 years, the surgery group exhibited a 20% reduction in the risk of MACE compared to the GLP-1 RA group (hazard ratio 0.80, 95% confidence interval 0.67-0.96, p=0.017). Furthermore, the surgery group demonstrated a 39% reduction in microvascular complications, including nephropathy, neuropathy, and retinopathy (hazard ratio 0.61, 95% confidence interval 0.49-0.76, p<0.0001).
While both groups experienced significant weight loss and improvements in HbA1c levels, the sustained benefits observed in the surgery group were markedly more pronounced. The study also noted a higher rate of serious adverse events in the surgery group,but researchers emphasize that these risks must be weighed against the long-term benefits of reduced cardiovascular and microvascular disease.
“These results clearly demonstrate that metabolic surgery offers a more durable and thorough benefit than medical therapy with GLP-1 receptor agonists in reducing the long-term complications of diabetes and obesity,” stated Dr. Heller.”The findings support the consideration of metabolic surgery as a key component of a comprehensive treatment strategy for eligible patients.”
the research was funded by the National Institute for Health and Care Research (NIHR) and supported by various international institutions. Further analysis is planned to explore the cost-effectiveness of metabolic surgery compared to ongoing medical management.
