Objective:

To synthesize current evidence examining the effects of metabolic and bariatric surgery (MBS) compared to GLP-1 receptor agonists (GLP-1 RAs) on all-cause mortality and nonfatal major adverse cardiac events (MACE) in individuals with obesity and type 2 diabetes mellitus (T2DM), highlighting the significance of this comparison in clinical decision-making.

Key Findings:

• MBS resulted in significant weight loss and improved glycemic control, with 31% to 56% remission of diabetes (p < 0.01).
• MBS showed a reduction in MACE (HR: 0.58, 95% CI: 0.51–0.66) and all-cause mortality (HR: 0.30, 95% CI: 0.15–0.62).
• GLP-1 RAs demonstrated 15–25% weight reduction but also reported weight regain after discontinuation.
• Both interventions have distinct risk-benefit profiles, with MBS associated with surgical complications and GLP-1 RAs linked to gastrointestinal adverse events.

Interpretation:

MBS appears to provide greater long-term benefits in reducing mortality and MACE compared to GLP-1 RAs for obese patients with T2DM, despite the risks associated with surgery, which should be carefully considered in clinical practice.

Limitations:

• Limited direct comparative evidence on long-term outcomes between MBS and GLP-1 RAs, particularly regarding specific biases such as selection and reporting bias.
• Potential biases in included studies and variability in study quality.

Conclusion:

MBS may be a more effective intervention than GLP-1 RAs in reducing mortality and major cardiac events in obese patients with T2DM, though both treatments have their own risks and benefits that must be weighed in clinical decision-making.