1-year outcomes of semaglutide, tirzepatide, and sleeve gastrectomy in obesity in type 2 diabetes: a retrospective cohort study

Sleeve gastrectomy was more likely than tirzepatide or semaglutide to achieve combined targets of at least 20% weight loss and HbA1c below 5.7% at 1 year, with tirzepatide outperforming semaglutide. This was a large retrospective US electronic health record study of adults with obesity and type 2 diabetes. Absolute rates of the composite outcome were modest even for surgery.

Journal article — retrospective cohort study. Population: Adults with BMI ≥35 kg/m² and HbA1c >6.4% (obesity and type 2 diabetes) in US electronic health records (Epic Cosmos). Sample size: 45,093 patients. Follow-up: 1 year. Interventions: semaglutide; tirzepatide; sleeve gastrectomy. Cited by 1 other paper.

Among 45,093 patients, the adjusted probability of achieving at least 20% bodyweight loss and HbA1c below 5.7% at 1 year was 3.0% (95% CI 2.8-3.2) for semaglutide, 13.2% (12.2-14.3) for tirzepatide, and 24.0% (22.9-25.1) for sleeve gastrectomy. Emergency department visits within 1 year were more frequent after sleeve gastrectomy than after semaglutide or tirzepatide. New prescriptions for gastro-oesophageal reflux disease and nausea occurred in all treatment groups, with higher absolute rates observed after sleeve gastrectomy.

This paper provides real-world comparative effectiveness data for tirzepatide against semaglutide and sleeve gastrectomy for weight and glycaemic targets at 1 year in people with obesity and type 2 diabetes. It suggests tirzepatide outperforms semaglutide but is less effective than surgery on the composite outcome. It does not establish causal efficacy or long-term safety, and baseline differences limit direct comparisons.

Key findings

• The adjusted probability of the primary composite outcome at 1 year was 24.0% (95% CI 22.9-25.1) for sleeve gastrectomy, 13.2% (12.2-14.3) for tirzepatide, and 3.0% (2.8-3.2) for semaglutide.
• Emergency department visits within 1 year were more frequent after sleeve gastrectomy than after semaglutide or tirzepatide.
• New prescriptions for gastro-oesophageal reflux disease and nausea occurred in all treatment groups, with higher absolute rates observed after sleeve gastrectomy.
• The final analysis included 45,093 patients: 33,482 on semaglutide, 4,178 on tirzepatide, and 7,433 who underwent sleeve gastrectomy.

Limitations

• Authors note baseline differences, including higher BMI, younger age, and lower baseline HbA1c in the sleeve gastrectomy group.
• Residual confounding is possible due to the observational retrospective design.
• Safety assessment was limited to emergency department visits and new prescriptions for gastro-oesophageal reflux disease or nausea.
• Primary analysis was restricted to patients with follow-up weight and HbA1c measured in the 9-month to 15-month window.

The record

• Journal: The lancet. Diabetes & endocrinology 14(8): 638-648
• Published: 2026-06-17
• PMID: 42309121 — DOI: 10.1016/s2213-8587(26)00030-6
• MeSH terms: Humans, Diabetes Mellitus, Type 2, Obesity, Weight Loss, Hypoglycemic Agents, Treatment Outcome, Gastrectomy, Retrospective Studies, Adult, Middle Aged, Female, Male, Glucagon-Like Peptides, Glycated Hemoglobin, Tirzepatide, Semaglutide
• Author countries: USA

Peptide profiles: Tirzepatide.

All indexed evidence: Tirzepatide trials & papers.

Related studies: Peripheral nerve complications from medications utilised for weight loss: a systematic…, Incretin-Based Therapies in Doxorubicin-Induced Cardiotoxicity: A Systematic Review of…, Effects of GLP-1 Receptor Agonists and Dual GIP/GLP-1 Receptor Agonists on Inflammatory…, Comparative effects of drugs for adults with overweight or obesity: systematic review….