Overview

• The Cleveland Clinic M6 cohort followed 3,932 adults for up to a decade, comparing gastric bypass or sleeve gastrectomy in 1,657 patients with GLP-1 therapy in 2,275 patients, including semaglutide and tirzepatide.
• Metabolic surgery was linked to a 32% lower risk of death, 35% fewer major cardiovascular events, 47% less nephropathy, and 54% less retinopathy compared with GLP-1 treatment.
• At 10 years, average body weight fell 21.6% after surgery versus 6.8% with GLP-1s, with larger HbA1c reductions (0.86 percentage points vs 0.23) and fewer prescriptions for diabetes, blood pressure, and cholesterol.
• Study leaders said surgery delivers durable benefits, including a possible survival advantage, and should be considered early in shared decision-making rather than reserved as a last resort.
• Authors noted the observational design and potential selection bias, and outside commentary highlighted that only a small proportion used the newest agent tirzepatide, reported at 4.4% of GLP-1 users.