Background

The STAMPEDE trial has long been the standard-bearer for the efficacy of surgical therapy in the reduction, and in many cases, elimination of medical diabetic therapy. In this hallmark paper, surgical therapy had been proven both initially and at 5 year follow up to be superior to medical management alone with regard to medication burden, glycemic control, and weight loss. However, advances in medical therapy, particularly GLP-1 agonists, have made medical weight loss and glycemic control more effective. In this study, we propose a protocol for a randomized, controlled study seeking to evaluate the validity of the STAMPEDE trial using GLP-1 agonists with respect to glycemic control and weight loss. Specifically, whether surgical therapy (sleeve gastrectomy or gastric bypass) is superior to GLP-1 agonist in terms of hemoglobin A1c, fasting glucose, and %EWL.