The comparative effects of metabolic surgery,SGLT2i,or GLP-1RA in patients with obesity and type 2 diabetes: a retrospective cohort study |
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| Affiliation: | 1. Department of Family Medicine and Primary Care, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China;2. Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China;3. Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, New Territories, Hong Kong, China;4. Research Department of Policy and Practice, University College London School of Pharmacy, London, United Kingdom;5. Division of Surgery, Chinese University of Hong Kong Medical Centre, Hong Kong, China;6. Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;7. Department of Family Medicine and Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China;8. Health Economics and Health Technology Assessment, Institute of Health & Well-Being, University of Glasgow, United Kingdom;9. Department of Surgery, Prince of Wales Hospital, Hong Kong, China;1. Department of Minimally Invasive Digestive Surgery, Antoine Béclère Hospital, Clamart, France;2. Paris-Saclay University, Orsay, France;3. Department of Radiology, Antoine Béclère Hospital, Clamart, France;4. Department of Hepato-Gastroenterology and Nutrition, Antoine Béclère Hospital, Clamart, France;5. Interventional Endoscopy Unit, Private Hospital Des Peupliers-Ramsay Santé, Paris, France;1. Department of Internal Medicine, Spaarne Gasthuis, Hoofddorp, the Netherlands;2. Department of Internal and Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands;3. Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, the Netherlands;4. Department of Surgery, Spaarne Gasthuis, Hoofddorp, the Netherlands;5. Department of Epidemiology and Data Science, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands;6. Department of Pharmacy and Pharmacology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands;7. Department of Surgery, Flevoziekenhuis, Almere, the Netherlands;8. Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands;1. Department of Surgery, Mayo Clinic, Jacksonville, Florida;2. Georgia Institute of Technology, Atlanta, Georgia;3. Division of Health Care Delivery Research, Mayo Clinic, Jacksonville, Florida;1. Department of Surgery, Northwest Hospital, Randallstown, Maryland;2. Department of Surgery, Mayo Clinic, Rochester, Minnesota;3. George Washington University School of Medicine and Health Sciences, Washington, DC;4. Department of Surgery, The Johns Hopkins University, Baltimore, Maryland |
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| Abstract: | BackgroundNew antidiabetic agents (sodium-glucose cotransporter-2 inhibitor [SGLT2i] and glucagon-like peptide-1 receptor agonist [GLP-1RA]) and metabolic surgery have protective effects on metabolic syndromes.ObjectivesTo compare the changes of metabolic parameters and costs among patients with obesity and type 2 diabetes undergoing metabolic surgery and initiating new antidiabetic agents over 12 months.SettingHong Kong Hospital Authority database from 2006–2017.MethodsThis is a population-wide retrospective cohort study consisting of 2616 patients (1810 SGLT2i, 528 GLP-1RA, 278 metabolic surgery). Inverse probability treatment weighting of propensity score was applied to balance baseline covariates of patients with obesity and type 2 diabetes who underwent metabolic surgery, or initiated SGLT2i or GLP-1RA. Metabolic parameters and direct medical costs were measured and compared from baseline to 12 months in metabolic surgery, SGLT2i, and GLP-1RA groups.ResultsPatients in all 3 groups had improved metabolic parameters over a 12-month period. Patients with metabolic surgery achieved significantly better outcomes in BMI (?5.39, ?.56, ?.40 kg/m2, P < .001), % total weight loss (15.16%, 1.34%, 1.63%, P < .001), systolic (?2.21, ?.59, 1.28 mm Hg, P < .001) and diastolic (?1.16, .50, ?.13 mm Hg, P < .001) blood pressure, HbA1c (?1.80%, ?.77%, ?.80%, P < .001), triglycerides (?.64, ?.11, ?.09 mmol/L, P < .001), and estimated glomerular filtration rate (3.08, ?1.37, ?.41 mL/min/1.73m2, P < .001) after 12 months compared with patients with SGLT2i and GLP1-RA. Although the metabolic surgery group incurred the greatest direct medical costs (US$33,551, US$10,945, US$10,627, P < .001), largely due to the surgery itself and related hospitalization, the total monthly direct medical expenditure of metabolic surgery group became lower than that of SGLT2i and GLP-1RA groups at 7 months.ConclusionBeneficial weight loss and metabolic outcomes at 12 months were observed in all 3 groups, among which the metabolic surgery group showed the most remarkable effects but incurred the greatest medical costs. However, studies with a longer follow-up period are warranted to show long-term outcomes. |
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| Keywords: | Metabolic surgery New antidiabetic agents Obesity Cohort study Type 2 diabetes |
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