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Gastric bypass surgery appears to reduce diabetic nephropathy
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Adults with type 2 diabetes and obesity undergoing gastric bypass surgery may see improvements in symptoms of nephropathy compared with similar patients receiving medical care with no surgery, according to research in Diabetologia.
In a prospective, case-control study comparing adults undergoing bariatric surgery with patients receiving medical care but no surgical intervention, researchers also found that patients who underwent surgery experienced worsening or improving retinopathy and neuropathy at the same rate as those in the nonsurgical arm.
Alexander D. Miras, PhD, of the division of diabetes, endocrinology and metabolism at Imperial College London, and colleagues analyzed data from 70 patients with type 2 diabetes and obesity (mean age, 51 years; 53 men; 46 white; baseline BMI, 43.6 kg/m²) undergoing gastric bypass surgery. They were matched for age, sex and duration of diabetes to 25 medical patients with type 2 diabetes and obesity (mean age, 53 years; 44 men; 16 white; baseline BMI, 42 kg/m²) who did not undergo surgery but were treated at the same bariatric surgery center.
Researchers measured BMI, HbA1c and blood pressure, and assessed medication use and microvascular complications in participants 6 months before and 12 to 18 months after intervention. Nephropathy was evaluated with early morning urine albumin-to-creatinine ratio measurements. Researchers assessed retinopathy with two-field digital retinal images, and they used motor and sensory nerve conduction studies to measure peripheral neuropathy.
The urine albumin-to-creatinine ratio decreased in the surgery arm at 1 year, from 3.6 mg/mmol to 1.7 mg/mmol (P = .02) vs. an increase in the nonsurgical arm, from 1.8 mg/mmol to 3.6 mg/mmol (P = .03).
Researchers found no significant differences between the gastric bypass arm and the nonsurgical arm in the rates of patients who experienced improved or worsened retinopathy symptoms. Nerve conduction variables at 1 year also were similar between the two arms.
Significant reductions were observed in the use of glucose-lowering and BP-lowering medications in the surgical group, but not in the medical group.
“It was reassuring to observe that the rates of patients experiencing worsening in retinopathy in the [gastric bypass] group was not in excess to those observed in patients receiving medical care based on international guidelines,” the researchers wrote. “The stability of neuropathy after 1 year was also reassuring.”
The mechanisms of improvement in albuminuria after gastric bypass surgery remain unclear, according to researchers.
“We expect that despite the lack of correlations, the reductions in [BP], HbA1c and BMI contributed to the observed reductions in [albumin-to-creatinine ratio],” the researchers wrote. – by Regina Schaffer
Disclosure: The researchers report no relevant financial disclosures.
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