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Cardiovascular and diabetes outcomes among patients with obesity and type 2 diabetes after metabolic bariatric surgery or glucagon-like peptide 1 receptor agonist treatment.
British Journal of Surgery ( IF 8.6 ) Pub Date : 2024-08-30 , DOI: 10.1093/bjs/znae221
Erik Stenberg 1 , Johan Ottosson 1 , Yang Cao 2, 3 , Magnus Sundbom 4 , Erik Näslund 5
Affiliation  

BACKGROUND With the increasing prevalence of obesity and type 2 diabetes, the availability of different treatment options remains essential. Studies comparing the outcomes of glucagon-like peptide 1 receptor agonists with those of metabolic bariatric surgery in patients with type 2 diabetes and obesity are lacking. METHODS Using propensity score matching, based on data from several nationwide clinical registries, patients who underwent primary metabolic bariatric surgery (Roux-en-Y gastric bypass or sleeve gastrectomy) were matched with patients who received glucagon-like peptide 1 receptor agonists. Outcome measures included the occurrence of major cardiovascular events, microvascular complications, and potential side effects (alcohol/substance abuse, self-harm, and fractures). RESULTS Over a mean follow-up of 7 years, major cardiovascular events occurred in 191 of 2039 patients (cumulative incidence 14.5%) in the surgery group compared with 247 of 2039 patients (19.6%) in the glucagon-like peptide 1 receptor agonist group (HR 0.75 (95% c.i. 0.62 to 0.91), P = 0.003). Patients in the surgery group had lower haemoglobin A1c values 5 years after treatment (mean difference 9.82 (95% c.i. 8.51 to 11.14) mmol/mol, P < 0.001) and fewer microvascular complications (retinopathy HR 0.88 (95% c.i. 0.79 to 0.99), P = 0.039; nephropathy HR 0.72 (95% c.i. 0.66 to 0.80), P < 0.001; and neuropathy or leg ulcers HR 0.82 (95% c.i. 0.74 to 0.92), P < 0.001), but a higher risk of alcohol/substance abuse (HR 2.56 (95% c.i. 1.87 to 3.50), P < 0.001), self-harm (HR 1.41 (95% c.i. 1.17 to 1.71), P < 0.001), and fractures (HR 1.86 (95% c.i. 1.11 to 3.12), P = 0.019). CONCLUSION Compared with glucagon-like peptide 1 receptor agonist treatment, metabolic bariatric surgery is associated with superior metabolic outcomes and a lower risk of major cardiovascular events in patients with type 2 diabetes and obesity, but a higher risk of alcohol/substance abuse, self-harm, and fractures.

中文翻译:


肥胖和 2 型糖尿病患者在代谢减肥手术或胰高血糖素样肽 1 受体激动剂治疗后的心血管和糖尿病结局。



背景随着肥胖和2型糖尿病的患病率不断增加,不同治疗方案的可用性仍然至关重要。目前还缺乏对 2 型糖尿病和肥胖患者的胰高血糖素样肽 1 受体激动剂与代谢减肥手术的结果进行比较的研究。方法 使用倾向评分匹配,根据多个全国性临床登记处的数据,将接受初次代谢减肥手术(Roux-en-Y 胃绕道术或袖状胃切除术)的患者与接受胰高血糖素样肽 1 受体激动剂的患者进行匹配。结果指标包括主要心血管事件、微血管并发症和潜在副作用(酒精/药物滥用、自残和骨折)的发生。结果 平均随访 7 年,手术组 2039 名患者中有 191 名患者发生重大心血管事件(累计发生率为 14.5%),而胰高血糖素样肽 1 受体激动剂组 2039 名患者中有 247 名患者发生重大心血管事件(累计发生率 19.6%)。 (HR 0.75(95% CI 0.62 至 0.91),P = 0.003)。手术组患者治疗 5 年后血红蛋白 A1c 值较低(平均差 9.82 (95% CI 8.51 - 11.14) mmol/mol,P < 0.001),微血管并发症较少(视网膜病变 HR 0.88 (95% CI 0.79 - 0.99) ),P = 0.039;肾病 HR 0.72(95% CI 0.66 至 0.80),P < 0.001;神经病或腿部溃疡 HR 0.82(95% CI 0.74 至 0.92),P < 0.001),但酒精/药物滥用(HR 2.56(95% ci 1.87 至 3.50),P < 0.001)、自残(HR 1.41(95% ci 1.17 至 1.71),P < 0.001)和骨折(HR 1.86(95 % CI 1.11 至 3.12), P = 0.019)。 结论 与胰高血糖素样肽 1 受体激动剂治疗相比,代谢减肥手术与 2 型糖尿病和肥胖患者的代谢结局较好,主要心血管事件风险较低,但酒精/药物滥用、自我滥用的风险较高。伤害和骨折。
更新日期:2024-08-30
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