The study compared adults with obesity and type 2 diabetes who had bariatric procedures or started obesity management medications. Of 379 858 adults, 32 401 had procedures and 347 457 started medications, balanced by overlap weighting. At 5 years, procedures were linked to less nephropathy (4.5% versus 8.3%) and retinopathy (3.6% versus 7.4%). Major adverse cardiovascular events (6.1% versus 8.1%) and all-cause mortality (2.1% versus 3.7%) were also lower. At 1 year, mean total weight loss was 25.4% versus 6.4%, and HbA1c normalisation 76.7% versus 47.2%. The design is observational, so unmeasured differences between groups may remain.
Why it is interesting: Incretin-based drugs now offer an alternative to bariatric procedures, so comparisons on hard outcomes matter. Here the procedures' advantage extended beyond weight to kidney, eye and cardiovascular events and death.
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