In anyone with obesity and diabetes, bariatric surgery is associated with greater relief in the threat of mortality to the first-generation GLP-1 agonist in patients with diabetes over the age of a decade, according to a study and retrospective by the coordinator of the condotto in Israel and published in JAMA Network Open.
Doctors using data from the electronic clinical card of Clalit Health Services, the largest fitness organization in Israel, have 6,070 treatments in 24 years and are able to diagnose diabetes after the age of 21 and with a body mass index (BMI) of around 30. Patients for bariatric surgery or GLP-1 agonist treatment from January 2008 to December 2021 have an initial ratio of 1:1 depending on condition, course and clinical characteristics.
Note that the trial only includes first-generation GLP-1 agonists, namely liraglutide (61. 9%), dulaglutide (21. 2%), exenatide (13. 6%), lixisenatide (1. 4%), insulin degludec and liraglutide (1. 6%), or insulin degludec and lixisenatide (0. 3%) and do not involve newer agents such as semaglutide or tirzepatide, which have more pronounced effects on weight loss.
The status of the media is 51 years old and 64. 9% women. The majority present hyperlipidemia and/or basal hypertension. Negligent users of GLP-1 agonists and baseline glycemic hemoglobin (HbA1c) levels will be particularly higher in patients who do not receive surgical treatment (9. 1% vs. 7. 5%). Some exclusion criteria include a cancer diagnosis within the past 2 years, end-stage renal disease, pregnancy, and a history of ischemic disease, ischemic stroke, or congested heart failure.
Bariatric surgery procedures include laparoscopic flexion (12. 4%), Roux-en-Y gastric bypass (46. 4%), and manic gastrectomy (41. 2%). Administer GLP-1 agonists that were insured for about 6 months over a 12-year period. consecutive months.
The models are tailored to diabetes duration, status, ethnicity, BMI, HbA1c level, socioeconomic status, diagnosis of atrial fibrillation, hyperlipidemia and hypertension, smoking, use of renin-angiotensin formula agents, lipid-modifying agents, insulin, SGLT2 inhibitors and other ipogligemizzanti drugs.
Lower mortality with diabetes surgery lasting less than 10 years During a median follow-up of 6. 8 years, bariatric surgery in patients with diabetes of shorter duration (up to 10 years) is associated with a 62% relief in mortality due to the use of GLP-1 agonists (HR 0. 38). However, due to BMI variation, this glue is not considered significant (HR 0. 79).
“The reason social survival gains advantages is compared to the commitment of massive weight loss follow-up suggests that the relationship with treatment type and all-cause mortality mediates the weight loss entity,” the Orna Reges authors wrote. guides from Ariel University in Israel.
With a duration of diabetes greater than 10 years, about a quarter of the rib in the study, bariatric surgery did not produce significant end-of-life advantages sopravvivenza ripetto ai farmaci (HR 0. 65), even though a higher risk Longo ended BMI at the lowest point compared to GLP-1 agonist (still -21. 9% vs. -7. 2%).
“This importance can be noted through the effects of long-lung diabetes, which mask and gain advantages from an agreement with weight reduction. Other people would possibly have a source of income in this result, such as the investment and the smaller size of the champion with long-standing diabetes” hanno spiegato gli autori. “This result is in line with the signs of a primary prevention of diabetes complications, dopo-bariatric surgery in patients with a shorter duration of diabetes. “
Nessuno dei due treatments have ridotto in significant measure there is one of non-fatal primary cardiovascular events, due to myocardial infarction, stroke and disease of the ischemic center:
At the same time, as the authors concluded that this study was of interest to them, with a duration of diabetes equal to or less than 10 years and no history of cardiovascular disease or congested center failure, bariatric surgery was related to mortality. Regardless, the final results of GLP-1 agonist treatment are a decrease at a median follow-up of 6. 8 years. Weight regain is a prestige known as a mediating agent in this association. There is no need for the State to differentiate between mortality-threatened weight reduction interventions with longer duration of diabetes (>10 years) due to the threat of MACE.
Reference
Dicker D et al. Bariatric metabolic receptor agonists versus glucagon-like peptide 1 and mortality. JAMA Open Network. June 3, 2024;7(6):e2415392.
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