1-year outcomes of semaglutide, tirzepatide, and sleeve gastrectomy in obesity in type 2 diabetes: a retrospective cohort study
Authors' conclusion
At 1 year after the index date, sleeve gastrectomy was associated with the highest probability of attaining combined weight and glycaemic targets, followed by tirzepatide and semaglutide.
Study context
- Population
- Adults with BMI ≥35 kg/m² and HbA1c >6.4% (obesity and T2D), Epic Cosmos EHR data from 1633 hospitals and 37,900 clinics across 280 US health systemsprimary outcome analysis
- Participants
- 45,093 adults
- Exposure
- Semaglutide vs tirzepatide vs SG
- Semaglutiden = 33,482
- Tirzepatiden = 4,178
- Sleeve gastrectomyn = 7,433
- Outcome
- Attainment of ≥20% bodyweight loss and HbA1c <5.7%
- Follow-up
- 1 year after the index date
Methodological detailsreal-world, electronic health record dataset (Epic Cosmos), multivariable logistic regression
- Real-world
- Electronic health record dataset (Epic Cosmos)
- Multivariable logistic regression
Main finding
As reported in the abstract
Adjusted probability of ≥20% bodyweight loss and HbA1c <5.7% · 1 year
Observational data: associations, not effects.
Safety
ED visits within 1 year
- ED visits more frequent after SG than after semaglutide or tirzepatide
New prescriptions for gastro-oesophageal reflux disease and nausea · 1 year
- Occurred in all groups, varied in frequency; higher absolute rates after SG
- Analysed descriptively
Original publication
1-year outcomes of semaglutide, tirzepatide, and sleeve gastrectomy in obesity in type 2 diabetes: a retrospective cohort study. Lancet Diabetes Endocrinol. Published 17 June 2026. doi:10.
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