The Comparison of Outcomes Between Metabolic Bariatric Surgery and Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RA) After Three Tears

OBJECTIVES: This study aims to compare the changes of weight, obesity-related comorbidity lab values, vitals, and healthcare utilization between metabolic bariatric surgery (MBS) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) three years after initiation.

METHODS: This was a single-site, retrospective study using electronic health record data from a health system in Texas. Adults receiving MBS or GLP-1 RA between 01/01/2017 and 12/31/2020 were included. Patients who received both treatments were excluded. The treatment initiation date was the index date. The baseline period was 12 months before the index date. The follow-up period was three years after the index date. The difference in body mass index (BMI), obesity-related lab values, and annual healthcare visits were compared between baseline and follow-up periods. Descriptive statistics and linear regression were used to compare these differences between two treatments.

RESULTS: A total of 7160 patients (2481 patients received MBS) were included in the study. The MBS group patients were younger, had higher proportion of females, had lower proportion of diabetes, lived in lower incomes zip codes, and had higher baseline BMI. After controlling the baseline characteristics, MBS had a 5.66 kg/m² greater decrease in BMI (p<0.001) and 6.58 greater decrease in annual outpatient visits (p<0.001). GLP-1 RA had 0.16 greater decrease in %HbA1c (p=0.0186), 3.76 mg/dL greater decrease in LDL (p=0.0093), 0.18 greater decrease in annual hospitalization (p=0.003), and 0.87 greater decrease in annual inpatient length of stay (p<0.001). There was no significant difference in the changes in blood pressure and annual emergency visits between the two treatments.

CONCLUSIONS: MBS is associated with a higher weight loss, while GLP-1 RA is associated with improved HbA1c and LDL. The healthcare utilization results were mixed between two treatments. MBS and GLP-1 RA can be used together and should be further explored.