The article “Limited Comparative Evidence Between Metabolic Bariatric Surgery and Incretin-Based Pharmacotherapy for Weight Loss in Type 2 Diabetes” was published in the Journal of Diabetes with the co-authorship of Lela Shengelia, Associate Professor at the School of Health Sciences of the University of Georgia. The author herself answers our questions regarding the subject.
1. Why did you become interested in researching this topic?
In recent years, the possibilities for managing type 2 diabetes and obesity have changed significantly. Metabolic and bariatric surgery has long been considered one of the most effective methods for significant and sustained weight loss. However, the development of modern incretin-based pharmacotherapy, including GLP-1 receptor agonists and dual incretin therapy, has created entirely new treatment opportunities.
Against this background, the following question became particularly interesting: What do we know about the direct comparison of these two strategies in patients with type 2 diabetes? This is where an important scientific problem emerged — although there is a substantial body of literature on the effectiveness of both approaches separately, direct comparative evidence between them is much more limited. For this reason, we chose a systematic review and meta-analysis approach to assess the existing studies as systematically as possible and determine not only what the existing evidence tells us, but also what we still do not know.
The idea for this study also has an interesting academic history. It developed from the educational and research activities of our students. The first author of the article, Omar Baniowdeh, came up with the idea of applying the knowledge acquired during the educational process to a real research question. The idea gradually developed into a full-scale systematic review and meta-analysis, which was ultimately published in the Journal of Diabetes.
2. What impact could the results of this study have on people's lives?
Type 2 diabetes and overweight/obesity are closely interconnected conditions, and their management affects not only glycemic control, but also cardiovascular risk, quality of life, and long-term health outcomes. Accordingly, choosing the optimal treatment strategy has significant clinical and public health importance.
One of the main messages of our study is precisely that the choice of treatment should not be based solely on which method produces greater weight loss. The sustainability of the effect, the patient's individual condition, comorbidities, surgical risk, the need for long-term medication use, accessibility, cost, and the patient's own choice should all be taken into consideration.
At the same time, the systematic review showed us that the number of direct comparative studies between modern incretin-based therapy and metabolic surgery is still limited. Therefore, the practical significance of our paper is not limited to summarizing the existing results — it also clearly demonstrates where stronger and longer-term research evidence is needed so that clinical decisions can become even more informed in the future.
3. How can students become involved in this area of research, and why would you recommend that they do so?
This question is particularly important to me because connecting the educational process with research is one of the interesting aspects of this publication.
When studying public health, epidemiology, and biostatistics, students work with scientific literature and prepare their first literature reviews. It is important to me that this does not remain merely an academic assignment. I always try to show students that a good research question that emerges in the classroom or while completing an academic assignment can develop into a real scientific project.
This is exactly how this study developed. The first author of the article, Omar Baniowdeh, came up with the idea of working more deeply on a topic that interested him. We decided to go beyond the scope of a literature review and conduct a full systematic review and meta-analysis. Students were involved at various stages of the research, and as a result, the initial idea became a scientific paper published in an international peer-reviewed journal.
This was not our first such experience. Within the framework of the same research collaboration, a systematic review entitled “The Principle of Double Effect in Palliative Care: A Systematic Review of Ethical, Legal, and Clinical Perspectives” was previously prepared and published in BMC Palliative Care in 2026. Several students participated in both research projects, which is particularly important to me — one-time involvement gradually developed into more sustainable research collaboration.
I would definitely recommend that students become involved in research because learning research methodology only theoretically and conducting actual research are completely different experiences. Through this process, they learn how to formulate a research question correctly, find and critically evaluate scientific information, work with data, write academically, collaborate as a team, and, most importantly, think critically from a scientific perspective.
4. What were the main challenges and skills involved in conducting this research?
A systematic review, and especially a meta-analysis, is a methodologically quite complex type of research. One of the main challenges was finding studies in which metabolic/bariatric surgery and incretin-based pharmacotherapy were directly compared in patients with type 2 diabetes.
Heterogeneity between the studies was also an important challenge. Patient populations, treatment approaches, follow-up periods, and time points for assessing weight loss differed. Therefore, it was necessary not only to statistically combine the data, but also to interpret the design and clinical context of each study very carefully.
Such research requires the simultaneous use of several competencies: planning a systematic literature search, selecting studies according to clear criteria, extracting data, assessing the risk of bias, conducting biostatistical analysis, and critically interpreting the results.
For students, it was particularly valuable to see that a meta-analysis is not merely a statistical calculation. A properly formulated research question is the foundation of a good meta-analysis, while the significance of the final result depends on the quality of the evidence being combined.
5. What kind of response has this particular paper received so far?
The paper was recently published in the Journal of Diabetes, so it is still too early to assess its scientific impact — for example, citations or other bibliometric indicators.
However, an already very important result for me is that the study successfully went through the international peer-review process and was published in a scientific journal specializing in the field of diabetes. It is also particularly gratifying that the study was created as a result of collaboration with students, and that the University of Georgia has now expressed interest in introducing it to a wider audience.
In the future, it will be interesting to observe how the paper is used in subsequent research, because the scarcity of comparative evidence identified by us is itself an important research message and raises the need for new, better-designed direct comparative studies.
6. What additional funding and support did this research receive?
This research was not funded through a separate research grant. Its implementation was primarily based on the academic collaboration of the authors, student motivation, and research mentorship.
For me, this once again demonstrates that developing an important research idea does not always require significant financial resources. Particularly in the case of a systematic review, what is crucial is a well-formulated research question, methodological knowledge, access to scientific literature, teamwork, and consistent mentorship.
At the same time, a university environment that encourages research collaboration between students and academic staff is crucial to developing such projects. I believe this experience is particularly valuable for young researchers, as it lets them move from education to active academic research.
