More weight loss but similar HbA1c reduction seen with bariatric surgery vs. GLP-1 drugs
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Among adults with obesity, bariatric surgery conferred greater weight and BMI reductions than GLP-1 receptor agonist therapy, but effects on HbA1c were similar between the two modalities, researchers reported.
“For the first time in many decades, we now have emerging novel medical therapies for potent weight loss that compared with bariatric surgery without the surgical risks,” Shohinee Sarma, MD, MPH, FRCPC, physician and endocrinologist in the division of endocrinology and metabolism at the Leadership Sinai Centre for Diabetes in the Sinai Health System, Toronto, told Healio. “Due to the potent weight loss and glycemic benefits of GLP-1 receptor agonists, patients who wish to avoid the risks of bariatric surgery may wish to discuss the option of medical therapy with their health professionals.”
For this systematic review and meta-analysis, Sarma and colleagues, searched MEDLINE, MEDLINE In-Process, MEDLINE Epubs Ahead of Print, Embase Classic, Embase and Cochrane from inception to April 2021. The researchers extracted three randomized controlled trials and three observational studies that included a total of 332 adults with obesity with or without concurrent type 2 diabetes. All studies included an intervention involving GLP-1 receptor agonists or metabolic or bariatric surgeries.
Participants who underwent surgery lost more weight and had larger BMI decreases compared with those prescribed GLP-1 receptor agonists: mean difference in weight loss was –22.68 kg and mean difference in BMI decrease was –8.18 kg/m2 among the randomized controlled trials. In addition, among the observational studies, the mean difference between surgery and medication was –25.11 kg for weight loss and –10.6 kg/m2 for BMI decrease.
Researchers noted that only one of the three observational studies reported glycemic outcomes. When reviewing the randomized controlled trials, which all reported glycemic outcomes, the mean difference between surgery and medication in HbA1c was –1.28%, which was not significant. These results suggested that glycemic control with GLP-1 receptor agonists may be similar to that observed with metabolic surgeries for people with obesity and type 2 diabetes, according to the researchers.
Because many people with obesity have metabolic risks for insulin resistance and type 2 diabetes, GLP-1 receptor agonists and other newer diabetes medications may provide weight loss as well as optimal diabetes control without the risk for surgery, Sarma said.
“We need both long-term cohort studies and head-to-head randomized controlled trials comparing medical therapies with bariatric surgery on long-term patient important outcomes for people living with obesity,” Sarma said.
For more information:
Shohinee Sarma, MD, MPH, FRCPC, can be reached at shohinee.sarma@mail.utoronto.ca.
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