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Surgical procedure reduces the dangers of dying, coronary heart illness, kidney failure, and eye injury extra successfully than GLP-1 medicines.
A significant examine performed at Cleveland Clinic discovered that people with weight problems and kind 2 diabetes who underwent weight-loss surgical procedure lived longer and skilled fewer severe issues in contrast with these handled solely with GLP-1 receptor agonist medicine.
Over a 10-year interval, sufferers who had bariatric or metabolic surgical procedure misplaced extra weight, managed their blood sugar extra successfully, and required fewer drugs for diabetes and coronary heart illness. The findings have been revealed in Nature Drugs.
“Even with right this moment’s finest medicines, metabolic surgical procedure gives distinctive and lasting advantages for folks with weight problems and diabetes,” mentioned Ali Aminian, M.D., director of Cleveland Clinic’s Bariatric & Metabolic Institute and first investigator of the examine. “The advantages we noticed went past weight reduction. Surgical procedure was linked to fewer coronary heart issues, much less kidney illness, and even decrease charges of diabetes-related eye injury.”
GLP-1 (glucagon-like peptide-1) receptor agonists are a bunch of medication generally prescribed for kind 2 diabetes and weight problems, recognized to decrease well being dangers. Each surgical procedure and GLP-1 therapies enhance metabolism and cardiovascular outcomes.
Particulars of the M6 examine
The M6 examine (Macrovascular and Microvascular Morbidity and Mortality after Metabolic Surgical procedure versus Medicines) tracked 3,932 adults with diabetes and weight problems handled at Cleveland Clinic for as much as a decade. Of those, 1,657 underwent metabolic surgical procedure akin to gastric bypass or sleeve gastrectomy, whereas 2,275 obtained GLP-1 medicines, together with liraglutide, dulaglutide, exenatide, semaglutide, and tirzepatide.
On the finish of the examine, sufferers who had metabolic surgical procedure had a:
- A 32% discount within the danger of dying
- A 35% discount within the danger of main cardiovascular occasions (together with coronary heart assault, coronary heart failure, or stroke)
- A 47% discount within the probability of growing extreme kidney illness
- A 54% discount within the danger of diabetes-related eye injury (retinopathy)
On common, individuals who had metabolic surgical procedure misplaced 21.6% of their physique weight over 10 years, in contrast with 6.8% weight reduction in individuals who took GLP-1 medicines. Hemoglobin A1c, a marker of common blood sugar, improved extra with surgical procedure (-0.86%) than with GLP-1 medicines (-0.23%). Sufferers within the surgical procedure group additionally required fewer prescriptions for diabetes, blood strain, and ldl cholesterol.
Implications for therapy decisions
“Even within the period of those highly effective new medicine to deal with weight problems and diabetes, metabolic surgical procedure could present extra advantages, together with a survival benefit,” mentioned Steven Nissen, M.D., Chief Tutorial Officer of the Coronary heart, Vascular & Thoracic Institute at Cleveland Clinic and senior writer of the examine.
“Our findings point out that surgical procedure ought to stay an essential therapy choice for weight problems and diabetes,” mentioned Dr. Aminian. “These long-term advantages are more durable to attain with GLP-1 medicines alone, as many sufferers cease utilizing the drugs over time.”
In response to the authors, the examine has some limitations. It was observational somewhat than a randomized comparability of medication and surgical procedure, and it didn’t focus solely on the latest and best GLP-1 medicines. The researchers observe that future research ought to straight examine surgical procedure with newer GLP-1 therapies, akin to semaglutide and tirzepatide, to additional information therapy selections.
Reference: “Macrovascular and microvascular outcomes of metabolic surgical procedure versus GLP-1 receptor agonists in sufferers with diabetes and weight problems” by Hamlet Gasoyan, Mohammad Hesam Alavi, Alexander Zajichek, Nicholas J. Casacchia, Abdullah Al Jabri, James Bena, Xiaoxi Feng, Rickesha Wilson, Ricard Corcelles, W. Scott Butsch, Rishi P. Singh, Nikhil Das, Hejin Jeong, Amgad Mentias, W. H. Wilson Tang, Bartolome Burguera, Raul J. Rosenthal, Steven E. Nissen, Michael B. Rothberg and Ali Aminian, 16 September 2025, Nature Drugs.
DOI: 10.1038/s41591-025-03893-3
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