The comparative effects of metabolic surgery, SGLT2i, or GLP-1RA in patients with obesity and type 2 diabetes: a retrospective cohort study.

Abstract

BACKGROUND:

New antidiabetic agents (sodium-glucose cotransporter-2 inhibitor [SGLT2i] and glucagon-like peptide-1 receptor agonist [GLP-1RA]) and metabolic surgery have protective effects on metabolic syndromes.

OBJECTIVES:

To compare the changes of metabolic parameters and costs among patients with obesity and type 2 diabetes undergoing metabolic surgery and initiating new antidiabetic agents over 12 months.

SETTING:

Hong Kong Hospital Authority database from 2006-2017.

METHODS:

This is a population-wide retrospective cohort study consisting of 2616 patients (1810 SGLT2i, 528 GLP-1RA, 278 metabolic surgery). Inverse probability treatment weighting of propensity score was applied to balance baseline covariates of patients with obesity and type 2 diabetes who underwent metabolic surgery, or initiated SGLT2i or GLP-1RA. Metabolic parameters and direct medical costs were measured and compared from baseline to 12 months in metabolic surgery, SGLT2i, and GLP-1RA groups.

RESULTS:

Patients in all 3 groups had improved metabolic parameters over a 12-month period. Patients with metabolic surgery achieved significantly better outcomes in BMI (-5.39, -.56, -.40 kg/m2, P < .001), % total weight loss (15.16%, 1.34%, 1.63%, P < .001), systolic (-2.21, -.59, 1.28 mm Hg, P < .001) and diastolic (-1.16, .50, -.13 mm Hg, P < .001) blood pressure, HbA1c (-1.80%, -.77%, -.80%, P < .001), triglycerides (-.64, -.11, -.09 mmol/L, P < .001), and estimated glomerular filtration rate (3.08, -1.37, -.41 mL/min/1.73m2, P < .001) after 12 months compared with patients with SGLT2i and GLP1-RA. Although the metabolic surgery group incurred the greatest direct medical costs (US$33,551, US$10,945, US$10,627, P < .001), largely due to the surgery itself and related hospitalization, the total monthly direct medical expenditure of metabolic surgery group became lower than that of SGLT2i and GLP-1RA groups at 7 months.

CONCLUSION:

Beneficial weight loss and metabolic outcomes at 12 months were observed in all 3 groups, among which the metabolic surgery group showed the most remarkable effects but incurred the greatest medical costs. However, studies with a longer follow-up period are warranted to show long-term outcomes.

• Authors: Tingting Wu, Carlos K H Wong, Eric H M Tang, Kenneth K C Man, Simon K H Wong, Ivan Chi Ho Au, Emily T Y Tse, Esther W Y Chan, Eleanor Grieve, Olivia Wu, Enders K W Ng, Ian C K Wong
• Journal: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Surg Obes Relat Dis) Vol. 18 Issue 6 Pg. 762-771 (06 2022) ISSN: 1878-7533 [Electronic] United States
• PMID: 35300912 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Chemical References

• Glucagon-Like Peptide-1 Receptor
• Hypoglycemic Agents
• Sodium-Glucose Transporter 2 Inhibitors

Topics

• Bariatric Surgery
• Diabetes Mellitus, Type 2 (complications, drug therapy, surgery)
• Glucagon-Like Peptide-1 Receptor (agonists)
• Humans
• Hypoglycemic Agents (therapeutic use)
• Obesity (complications, surgery)
• Retrospective Studies
• Sodium-Glucose Transporter 2 Inhibitors (therapeutic use)
• Weight Loss