Weighty Decisions: Drugs or Surgery for Diabetes?
Curator: Dr. Sudipta Saha, Ph. D.
A multicenter retrospective cohort study published in The Lancet has evaluated the effectiveness of GLP-1 receptor agonists (GLP-1 RAs), including semaglutide and tirzepatide, versus bariatric surgery in managing type 2 diabetes and obesity. The study was conducted using data from real-world clinical settings involving adults with type 2 diabetes and a body mass index (BMI) over 30.
Patients treated with GLP-1 RAs were found to have significant improvements in glycemic control and weight loss; however, bariatric surgery led to more pronounced and sustained reductions in HbA1c and body weight over a 2-year follow-up. Cardio-metabolic benefits, including blood pressure and lipid profile improvements, were also more prominent in the surgery group.
Despite this, GLP-1 RAs were associated with a lower incidence of early complications and shorter recovery times. Adverse gastrointestinal events were commonly reported in both groups, though surgical complications were more severe but less frequent.
This study suggested that while bariatric surgery remains the most effective intervention for sustained weight and glycemic outcomes, GLP-1 RAs offer a safer, non-invasive alternative with substantial benefit, particularly for patients ineligible or unwilling to undergo surgery. The potential for GLP-1 RA therapy to delay or reduce the need for surgical intervention was also discussed.
These findings have emphasized the importance of personalized treatment strategies based on patient comorbidities, preferences, and risk profiles.
References:
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00145-2/fulltext
https://pubmed.ncbi.nlm.nih.gov/27222544
https://pubmed.ncbi.nlm.nih.gov/17715408
2012pharmaceutical
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