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：

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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 型糖尿病患病率的增加，不同治疗方案的可用性仍然至关重要。缺乏比较胰高血糖素样肽 1 受体激动剂与代谢性减重手术在 2 型糖尿病和肥胖患者中的结果的研究。方法 使用倾向评分匹配，根据来自几个全国临床登记的数据，将接受初次代谢减肥手术 （Roux-en-Y 胃旁路手术或袖状胃切除术） 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。结局指标包括主要心血管事件的发生、微血管并发症和潜在的副作用（酒精/物质滥用、自残和骨折）。结果 在平均 7 年的随访中，手术组 2039 例患者中有 191 例 （累积发生率 14.5%） 发生重大心血管事件，而胰高血糖素样肽 1 受体激动剂组 2039 例患者中有 247 例 （19.6%） 发生重大心血管事件 （HR 0.75 （95% CI 0.62 至 0.91），P = 0.003）。手术组患者在治疗后 5 年血红蛋白 A1c 值较低（平均差 9.82（95% CI 8.51 至 11.14）mmol/mol，P < 0.001）和较少的微血管并发症（视网膜病变 HR 0.88（95% CI 0.79 至 0.99），P = 0.039;肾病 HR 0.72（95% CI 0.66 至 0.80），P < 0.001;神经病变或腿部溃疡 HR 0.82（95% CI 0.74 至 0.92）， P < 0.001），但酒精/药物滥用风险较高 （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，代谢性减重手术与 2 型糖尿病和肥胖患者较高的代谢结局和较低的主要心血管事件风险相关，但酒精/物质滥用、自残和骨折的风险更高。