Weight-Loss Surgery Outperforms Diabetes Drugs for Long-Term Health, Cleveland Clinic Study Finds
A decade-long study conducted by researchers at Cleveland Clinic demonstrates that weight-loss surgery (bariatric or metabolic surgery) provides superior and more sustained health benefits for individuals with both obesity and type 2 diabetes compared to treatment with GLP-1 receptor agonist medications. The findings, published in Nature Medicine, suggest surgery remains a vital treatment option even with the advent of newer, powerful diabetes and weight-loss drugs like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound).
The “M6” study followed 3,932 adults with obesity and type 2 diabetes receiving care at Cleveland clinic. 1,657 patients underwent metabolic surgery - procedures like gastric bypass or sleeve gastrectomy – while 2,275 were treated with GLP-1 medications,including liraglutide,dulaglutide,exenatide,semaglutide,and tirzepatide.
After 10 years, the surgical group experienced significantly improved health outcomes. Specifically, patients who had surgery demonstrated a 32% reduction in the risk of death, a 35% lower risk of major cardiovascular events (heart attack, heart failure, stroke), a 47% lower risk of serious kidney disease, and a 54% lower risk of diabetes-related eye damage (retinopathy).
The study also revealed substantial differences in weight loss and blood sugar control. Surgical patients lost an average of 21.6% of their body weight, compared to 6.8% in the medication group. Hemoglobin A1c levels, a measure of blood sugar control, improved by -0.86% with surgery versus -0.23% with GLP-1 medications. Furthermore, surgical patients required fewer prescriptions for medications managing diabetes, blood pressure, and cholesterol.
“Even in the era of these powerful new drugs to treat obesity and diabetes, metabolic surgery may provide additional benefits, including a survival advantage,” stated Dr. Steven Nissen, Chief Academic Officer of the Heart, Vascular & Thoracic Institute at Cleveland Clinic and senior author of the study.
Dr. Ali Aminian, director of Cleveland Clinic’s Bariatric & Metabolic Institute and the study’s primary investigator, emphasized that the benefits extended beyond weight loss, encompassing improvements in heart health, kidney function, and eye health. he also noted that maintaining long-term benefits with GLP-1 medications can be challenging, as patient adherence frequently enough declines over time.
researchers acknowledge the study’s limitations, including its observational design (rather than a randomized controlled trial) and its focus on GLP-1 medications available during the study period. They recommend future research directly compare surgery with the newest and most effective GLP-1 therapies,such as semaglutide and tirzepatide,to refine treatment guidelines.