Sleeve gastrectomy bests incretin-based therapies for obesity, type 2 diabetes

In the real-world treatment of patients with obesity and type 2 diabetes, the probability of achieving combined weight and glycaemic targets is higher with sleeve gastrectomy than with either tirzepatide or semaglutide, according to a retrospective cohort study.

Researchers used data from Epic Cosmos and looked at adults with a BMI of ≥35 kg/m² and HbA_1c above 6.4 percent who had received at least 12 months of semaglutide or tirzepatide treatment and reached maintenance doses or who underwent sleeve gastrectomy.

A total of 468,712 patients with at least 365 consecutive days of semaglutide or tirzepatide prescriptions and 238,028 patients who underwent sleeve gastrectomy were identified. Of these, 33,482 semaglutide-treated patients, 4,178 tirzepatide-treated patients, and 7,433 who underwent sleeve gastrectomy were included in the analyses.

The probability of achieving the primary composite outcome of at least 20-percent reduction in body weight and HbA_1c below 5.7 percent at 1 year was highest for sleeve gastrectomy at 24 percent. This was followed by tirzepatide at 13.2 percent and then semaglutide at 3 percent.

However, emergency department visits within 1 year occurred more frequently in the sleeve gastrectomy group than in the semaglutide and tirzepatide groups. All patients received new prescriptions for gastro-oesophageal reflux disease and nausea, but the rate was higher in the sleeve gastrectomy group.

The primary outcome was achievement of ≥20 percent reduction in bodyweight and HbA_1c below 5.7 percent at 1 year after the index date.

The researchers advised careful interpretation of the findings, given that patients in the sleeve gastrectomy group had higher BMI, younger age, and lower HbA_1c at baseline than those in the tirzepatide and semaglutide groups.