Bariatric Metabolic Surgery vs Glucagon-Like Peptide-1 Receptor Agonists and Mortality
Authors' conclusion
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.
Study context
- Population
- Adults aged ≥24 years with diabetes and obesity and no prior ischemic heart disease, ischemic stroke or congestive HF, Clalit Health Services, Israel (2008–2021); mean age 51.0 years, 64.9% women
- Participants
- 6,070 adults3,035 matched pairs
- Exposure
- Bariatric metabolic surgery (BMS) vs GLP-1 RA
- Outcome
- All-cause mortality
- Follow-up
- Median 6.8 years (IQR, 4.1-9.4 years)
Methodological detailsobservational, matched 1:1 by age, sex and clinical characteristics
- Observational
- Matched 1:1 by age, sex and clinical characteristics
Main finding
As reported in the abstract
BMS vs GLP-1RAsHazard ratio (95% CI)
Diabetes duration ≤10 years (2371 pairs)
0.38(0.25–0.58)
Diabetes duration ≤10 years, model including weight loss; nonsignificant
0.79(0.43–1.48)
Diabetes duration >10 years (664 pairs); no survival advantage
0.65(0.39–1.08)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | HR (95% CI) | |
|---|---|---|
| Nonfatal MACEBMSvs GLP-1RAsDiabetes duration ≤10 years · multivariate competing risk models | 0.74 (0.49–1.10) | |
| Nonfatal MACEBMSvs GLP-1RAsDiabetes duration >10 years · multivariate competing risk models | 1.21 (0.80–1.85) | |
| 0.512Hazard ratio (log scale) |
Nonfatal MACE
- Risk of nonfatal MACE did not differ between the treatment groups
Original publication
Bariatric Metabolic Surgery vs Glucagon-Like Peptide-1 Receptor Agonists and Mortality. JAMA Netw Open. Published 3 June 2024. doi:10.
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