Comparative efficacy of therapy with SGLT-2 inhibitors and bariatric surgery in patients with class I obesity and type 2 diabetes

Class I obesity (BMI 30—34.9 kg/m2) is a disease that causes or aggravates multiple comorbidities, shortens life expectancy, and worsens quality of life. Objective. To compare the effectiveness of sodium-glucose cotransporter type 2 (SGLT2) inhibitors and bariatric surgery in the treatment of patients with class I obesity and type 2 diabetes mellitus (T2DM) in relation to BMI dynamics, the probability of T2DM remission, the risks of heart attack, stroke, and the risks of death from all causes. Material and methods. A retrospective “case-control study” was performed. Information on the effectiveness of conservative therapy was obtained from the Webiomed predictive analytics platform, which contains anonymized electronic patient records. Information on the effectiveness of surgical treatment was obtained from the Russian National Bariatric Registry database, which contains anonymized data on patients who underwent bariatric surgery. The study assessed the dynamics of the body mass index throughout the observation period, all-cause mortality, the proportion of individuals who had a cardiovascular event and the frequency of T2DM remission. Results. Information was obtained on 47 pairs of patients. After 36 months of observation, the median BMI in the therapeutic and surgical groups was 36 kg/m2 and 25 kg/m2, respectively (p<0.01), T2DM remission was achieved by 80.8 % of the operated patients, while in the conservative therapy group, the criteria for achieving T2DM remission were not achieved in any patient (p<0.01). In the conservative therapy group, the 3-year cumulative incidence of cardiovascular events was 25.5%, in the surgical treatment group — 2% (OR 0.50, 95% CI 0.006—0.405, p=0.005). In the 3-year perspective, death from all causes occurred in 8 patients in the conservative treatment group (mortality 17%), and in 12 patients in the 8-year perspective (mortality 25.5%), in the surgical treatment group, no patient died during the 3-year follow-up period (OR 0.40, 95% CI 0.002—0.718, p=0.029). Conclusion. The obtained results emphasize the need for a wider use of bariatric interventions in the Russian Federation and their inclusion in treatment protocols for patients with class I obesity and a high risk of cardiovascular events.