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- Title
Bariatric Metabolic Surgery vs Glucagon-Like Peptide-1 Receptor Agonists and Mortality.
- Authors
Dicker, Dror; Sagy, Yael Wolff; Ramot, Noga; Battat, Erez; Greenland, Philip; Arbel, Ronen; Lavie, Gil; Reges, Orna
- Abstract
Key Points: Question: How are bariatric metabolic surgery (BMS) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) associated with mortality and major adverse cardiovascular events (MACEs) among patients with obesity and diabetes? Findings: In this cohort study comprising 6070 patients, among individuals with a diabetes duration of 10 years or less, BMS was associated with a 62% reduction in mortality compared with GLP-1RAs, with weight reduction mediating the association. No difference was observed in the risk of mortality among those with a longer duration of diabetes, nor in the risk of MACEs among all patients. Meaning: This study suggests that BMS was associated with greater reduced mortality compared with GLP-1RAs among individuals with a diabetes duration of 10 years or less, mediated via greater weight loss. Importance: Evidence regarding the relative effectiveness of bariatric metabolic surgery (BMS) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) in reducing mortality and major adverse cardiovascular events (MACEs) is limited. Objective: To compare all-cause mortality and nonfatal MACEs associated with BMS vs GLP-1RAs for adults with obesity and diabetes and without known cardiovascular disease. Design, Setting, and Participants: This observational, retrospective cohort study was based on data obtained from the electronic medical records of Clalit Health Services (Clalit), the largest health care organization in Israel. The study included 6070 members aged 24 years or older, who had diabetes and obesity and no prior history of ischemic heart disease, ischemic stroke, or congestive heart failure. Patients who underwent BMS and patients who received GLP-1RAs from January 1, 2008, through December 31, 2021, were matched 1:1 by age, sex, and clinical characteristics. Follow-up ended December 31, 2022. Exposures: Initiation of BMS or GLP-1RAs. Main Outcomes and Measures: The primary outcome was all-cause mortality, assessed by multivariate Cox proportional hazards regression models. The secondary outcome was nonfatal MACEs, assessed by multivariate competing risk models. Results: The study included 3035 matched pairs of patients (total, 6070; mean [SD] age, 51.0 [9.5] years; 3938 women [64.9%]), who were followed up for a median of 6.8 years (IQR, 4.1-9.4 years). Among those with a diabetes duration of 10 years or less (2371 pairs), mortality was lower for those who underwent BMS than for those treated with GLP-1RAs (hazard ratio [HR], 0.38; 95% CI, 0.25-0.58). This association became nonsignificant when weight loss during the follow-up period was also included in the model (HR, 0.79; 95% CI, 0.43-1.48). Among patients with a duration of diabetes longer than 10 years (664 pairs), no survival advantage was demonstrated for BMS over GLP-1RA (HR, 0.65; 95% CI, 0.39-1.08). The risk for nonfatal MACEs did not differ 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). Conclusions and Relevance: In this cohort study, BMS was associated with greater reduced mortality compared with first-generation GLP-1RAs among individuals with a diabetes duration of 10 years or less, mediated via greater weight loss. No differences in the risk for mortality were observed between the treatment modalities among individuals with a longer duration of diabetes, nor in the occurrence of nonfatal MACEs among all patients. This cohort study compares all-cause mortality and major adverse cardiovascular events associated with bariatric metabolic surgery vs glucagon-like peptide-1 receptor agonists for adults with obesity and diabetes.
- Subjects
ISRAEL; BARIATRIC surgery; GLUCAGON-like peptide-1 agonists; DISEASE duration; SCIENTIFIC observation; MULTIPLE regression analysis; DESCRIPTIVE statistics; RETROSPECTIVE studies; LONGITUDINAL method; MATHEMATICAL models; THEORY; CONFIDENCE intervals; COMPARATIVE studies; DATA analysis software; OBESITY; DIABETES; PROPORTIONAL hazards models; ADULTS
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2415392
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.15392