Study wrapper · #171
1-year outcomes of semaglutide, tirzepatide, and sleeve gastrectomy in obesity in type 2 diabetes: a retrospective cohort study.
Editor's note
This large real-world retrospective cohort (Epic Cosmos; 45,093 analysed) compares one-year outcomes of semaglutide, tirzepatide, and sleeve gastrectomy in adults with obesity and type 2 diabetes. The demanding composite endpoint — at least 20% weight loss plus HbA1c below 5.7% — was reached by an adjusted 3.0% on semaglutide, 13.2% on tirzepatide, and 24.0% after surgery, placing tirzepatide between the two. Emergency-department visits and new reflux/nausea prescriptions were more frequent after surgery. The scale is a strength, but the authors are candid about limitations: the groups differed at baseline (the surgical cohort was younger, heavier, with lower HbA1c), and residual confounding plus a narrow safety scope constrain interpretation. This is not a randomised comparison, and one-year data cannot speak to durability. Consistent with tirzepatide outperforming semaglutide on weight while surgery remains most potent, weigh it as informative real-world benchmarking — hypothesis-refining, not a definitive ranking.
Plain-language abstract
Using records from hundreds of US health systems, researchers compared three treatments for people with obesity and type 2 diabetes: semaglutide, tirzepatide, and sleeve gastrectomy (weight-loss surgery). They measured how many people hit a demanding combined goal within one year — losing at least 20% of body weight and getting blood sugar (HbA1c) below 5.7%. After statistical adjustment, about 3% reached this goal on semaglutide, about 13% on tirzepatide, and about 24% after surgery. Emergency-department visits and new prescriptions for reflux or nausea were more common after surgery than with the medications. The authors caution that the groups were not the same to begin with — surgery patients tended to be younger, heavier, and have lower starting blood sugar — and that this was not a randomised trial, so other differences may affect the results. They also note the one-year window and limited safety measures. Overall, surgery achieved the combined target most often, with tirzepatide ahead of semaglutide.