Cardiovascular and diabetes outcomes among patients with obesity and type 2 diabetes after metabolic bariatric surgery or glucagon-like peptide 1 receptor agonist treatment.

IF 8.6 1区医学 Q1 SURGERY

British Journal of Surgery Pub Date : 2024-08-30 DOI:10.1093/bjs/znae221

Erik Stenberg, Johan Ottosson, Yang Cao, Magnus Sundbom, Erik Näslund

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引用次数: 0

Abstract

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.

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肥胖症和 2 型糖尿病患者接受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预后。

背景：随着肥胖和 2 型糖尿病发病率的增加，提供不同的治疗方案仍然至关重要。目前还缺乏比较胰高血糖素样肽 1 受体激动剂与代谢减肥手术对 2 型糖尿病和肥胖症患者治疗效果的研究：根据几个全国性临床登记处的数据，采用倾向得分匹配法，将接受初级代谢减肥手术（Roux-en-Y 胃旁路术或袖带胃切除术）的患者与接受胰高血糖素样肽 1 受体激动剂治疗的患者进行匹配。结果测量包括主要心血管事件、微血管并发症和潜在副作用（酗酒/滥用药物、自残和骨折）的发生率：在平均7年的随访期间，手术组2039名患者中有191名（累计发生率14.5%）发生了重大心血管事件，而胰高血糖素样肽1受体激动剂组2039名患者中有247名（19.6%）发生了重大心血管事件（HR 0.75（95% c.i.0.62至0.91），P = 0.003）。手术组患者治疗 5 年后的血红蛋白 A1c 值更低（平均差异为 9.82 (95% c.i. 8.51 至 11.14) mmol/mol，P < 0.001），微血管并发症更少（视网膜病变 HR 0.88 (95% c.i. 0.79 至 0.99)，P = 0.039；肾病 HR 0.72 (95% c.i. 0.66 至 0.80)，P < 0.001; and neuropathy or leg ulcers HR 0.82 (95% c.i. 0.74 to 0.92), P < 0.001)，但酗酒/滥用药物的风险更高（HR 2.56 (95% c.i. 1.87至3.50），P <0.001）、自残（HR 1.41（95% c.i.1.17至1.71），P <0.001）和骨折（HR 1.86（95% c.i.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，代谢减肥手术对 2 型糖尿病和肥胖症患者的代谢效果更佳，发生主要心血管事件的风险更低，但酗酒/滥用药物、自残和骨折的风险更高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

British Journal of Surgery 医学-外科

CiteScore

12.70

自引率

7.30%

发文量

1102

审稿时长

1.5 months

期刊介绍： The British Journal of Surgery (BJS), incorporating the European Journal of Surgery, stands as Europe's leading peer-reviewed surgical journal. It serves as an invaluable platform for presenting high-quality clinical and laboratory-based research across a wide range of surgical topics. In addition to providing a comprehensive coverage of traditional surgical practices, BJS also showcases emerging areas in the field, such as minimally invasive therapy and interventional radiology. While the journal appeals to general surgeons, it also holds relevance for specialty surgeons and professionals working in closely related fields. By presenting cutting-edge research and advancements, BJS aims to revolutionize the way surgical knowledge is shared and contribute to the ongoing progress of the surgical community.