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OUTCOMES IN PATIENTS WITH TYPE 2 DIABETES WITH MASH AND MASLD: A COMPARISON BETWEEN BARIATRIC SURGERY AND GLP-1 AGONISTS
Zehra Naseem
*1, Varun Aitharaju
1, Aun Muhammad
2, Arjun Chatterjee
1, Stephen A. Firkins
1, Roma Patel
1, Akash Khurana
1, Roberto Simons-Linares
1, Bailey Flora
1, Erika Staneff
1, Rehan Haidry
31Internal Medicine, Cleveland Clinic, Cleveland, OH; 2The University of Mississippi Medical Center, Jackson, MS; 3Cleveland Clinic London Ltd, London, England, United Kingdom
Introduction: Achieving weight loss and glycemic control remains challenging for patients with metabolic dysfunction-associated steatotic liver disease (MASLD)/metabolic dysfunction associated steatohepatitis (MASH) with obesity and type 2 diabetes. Cardiovascular disease stands as the leading cause of morbidity and mortality in this population. Weight loss interventions with bariatric surgery (BS) and GLP-1 agonists mitigate risk for cardiovascular diseases and cirrhosis. However, comparative outcomes of BS vs. GLP-1 agonists for outcomes of MASH/MASLD remain poorly understood. This study aimed to assess whether BS or GLP-1 agonists improve outcomes for patients with MASH/MASLD.
Methodology: We conducted a global retrospective cohort study using the TriNetX database between 1/1/2014-12/12/2023. Adult patients with BMI ? 30 kg/m2, type 2 diabetes and MASLD/MASH were identified through ICD-10-CM codes and included. Patients in the BS group were matched to GLP-1 agonist group by 1:1 propensity matching according to age, demographics, socioeconomic factors, comorbidities, and medications. Patients with any prior history of non-MASLD/MASH related liver disease, major cardiovascular diseases, and cirrhosis were excluded. Key outcomes were defined as all-cause mortality, incidence of cirrhosis, major adverse cardiovascular outcomes, and chronic kidney disease (CKD), 5 and 10 years of being on GLP-1 or after BS.
Results: We identified 1,450 patients in the BS group and 30,788 patients in GLP-1 agonists group. After propensity score matching, we included 1,441 patients in each patient cohort. There was no difference in mortality and major non-fatal cardiovascular outcomes between the two groups in 5 years and 10 years (Table 1 and Table 2). Patients in BS group had lower risk of CKD in 5 years and 10 years, while patients in GLP-1 group had lower risk of hypertension in 5 years and 10 years (Table 1 and Table 2). No patients in either group developed liver cirrhosis at 5 or 10 years.
Conclusion: These findings indicate that BS and GLP-1 receptor agonists provide comparable outcomes for major adverse cardiovascular events, all-cause mortality, and cirrhosis development in patients with diabetes, MASLD/MASH, and obesity. However, the BS group exhibited a lower risk of CKD, highlighting the distinctive reno-protective advantages of surgical intervention in this population, even though GLP-1 is associated with improved hypertension outcomes. The cardiovascular effects of GLP-1 receptor agonists, such as vasodilation and autonomic function modulation, may achieve a more robust and consistent reduction in blood pressure compared to the indirect mechanisms of BS.
Table 1: 5 years outcomes of MASLD/MASH in bariatric surgery vs GLP-1 agonists
Table 2: 10 years outcomes of MASLD/MASH in bariatric surgery vs GLP-1 agonists
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