Endocrinology · Surgery · 2 h ago
Bariatric surgery linked to lower diabetes complications than obesity medications
In a nationwide overlap-weighted cohort of 379,858 adults with obesity and type 2 diabetes, metabolic bariatric surgery was associated with greater weight loss and glycaemic normalization than starting obesity management medications. Over five years, surgery was also associated with lower rates of kidney and eye complications, major cardiovascular events, and death.
- Cohort included 379,858 adults with obesity and type 2 diabetes.
- MBS was associated with lower five-year risks of complications and death.
- One-year weight loss was 25.4% after surgery versus 6.4% with medications.
- Observational design limits causal interpretation.
Researchers compared adults aged 18 years or older with obesity and type 2 diabetes who underwent metabolic bariatric surgery (MBS; 32,401 patients) or initiated obesity management medications (OMMs; 347,457 patients). Overlap weighting was used to balance baseline characteristics. Median follow-up was 4.9 years after MBS and 4.3 years after medication initiation. Outcomes included five-year risks of nephropathy, retinopathy, major adverse cardiovascular events (MACE), and all-cause mortality, as well as one-year weight loss and glycaemic control.
At five years, MBS was associated with lower cumulative incidence of nephropathy (4.5% versus 8.3%; hazard ratio [HR] 0.55), retinopathy (3.6% versus 7.4%; HR 0.60), MACE (6.1% versus 8.1%; HR 0.78), and all-cause mortality (2.1% versus 3.7%; HR 0.61). At one year, mean total weight loss was 25.4% after MBS versus 6.4% with OMMs. Among patients with baseline HbA1c of at least 6.5%, 76.7% after MBS and 47.2% after OMMs had HbA1c below 6.5%.
The findings suggest greater long-term benefit associated with surgery in this cohort, but the comparison is observational and cannot establish causality. Results compare surgery with real-world medication initiation and do not establish comparative effects for specific drugs.
In practice
For adults with obesity and type 2 diabetes represented in this cohort, metabolic bariatric surgery was associated with greater one-year weight loss and glycaemic normalization, and lower five-year rates of microvascular complications, MACE, and death than initiation of obesity management medications. These findings may inform discussion of treatment options, but they do not demonstrate that surgery caused the differences: the study was observational, and medication initiation was evaluated as a broad real-world comparator rather than a comparison with specific agents.
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British Journal of Surgery (BJS): Cardiovascular and diabetes outcomes after metabolic bariatric surgery versus obesity management medications: nationwide overlap-weighted cohort study of 379 858 patients ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.