Macrovascular and microvascular outcomes of metabolic surgery versus GLP-1 receptor agonists in patients with diabetes and obesity
Main finding · All-cause mortality, 10-year cumulative incidenceResult — go to the resultAdjusted hazard ratio 0.68 95% CI 0.48–0.96Authors' conclusion
These findings indicate that even with the availability of GLP-1 RAs, metabolic surgery remains superior to medical treatment.
Study context
- Population
- Patients with T2D and obesity; 65.7% female (surgery), 53.5% female (GLP-1 RA)
- Participants
- 1,657 vs 2,275
- Exposure
- Metabolic surgery vs GLP-1 RA
- Metabolic surgeryn = 1,657
- GLP-1 RAn = 2,275reference
- Outcome
- Time to all-cause mortality, incident major adverse cardiovascular events (MACE), nephropathy and retinopathy
- Follow-up
- Median 5.9 years
Methodological detailsdoubly robust estimation to balance baseline characteristics
- Doubly robust estimation to balance baseline characteristics
Main finding
As reported in the abstract
All-cause mortality, 10-year cumulative incidence · 10 years
Adjusted hazard ratio
0.68
95% CI 0.48–0.96
P = 0.028
By group
Metabolic surgeryvs GLP-1 RA
aHR 0.68 (95% CI 0.48–0.96); P = 0.028
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | P value | |
|---|---|---|---|
| MACE | 0.65 (0.51–0.82) | P < 0.001 | |
| Nephropathy | 0.53 (0.43–0.67) | P < 0.001 | |
| Retinopathy | 0.46 (0.29–0.75) | P = 0.002 | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Original publication
Macrovascular and microvascular outcomes of metabolic surgery versus GLP-1 receptor agonists in patients with diabetes and obesity. Nat Med. Published 16 September 2025. doi:10.
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