Bariatric surgery may reduce risk for DR in patients with obesity, type 2 diabetes
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NEW ORLEANS — In patients with obesity and type 2 diabetes, bariatric surgery was found to be associated with fewer cases of diabetic retinopathy, according to a presenter at the American Academy of Ophthalmology meeting.
“Currently, bariatric surgery is the most effective treatment for obesity and type 2 diabetes. It has shown efficacy in inducing remission of diabetes and reducing other microvascular complications. However, its impact on diabetic retinopathy (DR) is unclear, and some early small trials suggest that early worsening of retinopathy post-surgery can occur due to the rapid improvements in hyperglycemia,” Caberry W. Yu, MD, of McMaster University in Canada, said. “This project aimed to estimate the impact of bariatric surgery on diabetic retinopathy for obese diabetic patients in comparison to standard medical treatment.”
Yu and colleagues conducted a systematic review and meta-analysis of 14 studies sourced from Medline, Embase, Cochrane Central and Web of Science databases searched from their inception to March 2020. The studies included 362,589 patients with type 2 diabetes and compared DR in patients who had undergone bariatric surgery vs. medical management. The primary outcome was the prevalence of all DR and sight-threatening DR, which was defined as proliferative or preproliferative DR, diabetic maculopathy or severe nonproliferative DR. The secondary outcome was worsening of DR within and beyond 12 months after surgery.
The prevalence of DR was 0.45% in patients who underwent bariatric surgery and 1.03% in patients who underwent medical management. Patients who underwent bariatric surgery had significantly lower postoperative prevalence of all DR at a median follow-up of 8 years and sight-threatening DR at a median follow-up of 4 years.
“Within the first 12 months of surgery, there were worsening of diabetic retinopathy and progression to sight-threatening DR, which occurred more often in patients with more severe baseline DR prior to surgery,” Yu said. “For patients who had nonproliferative DR at baseline, early progression of all DR was not significantly different between surgical and control patients.”
After the first 12 months, at a median follow-up of 5 years, bariatric surgery resulted in significantly fewer patients with worsened DR. However, progression still occurred in up to 8% of patients followed between 2 to 13 years after surgery.
“The severity of DR at baseline was a really important sign for early worsening of diabetic retinopathy postoperatively, and early vigilant DR screening for patients with existing sight-threatening DR who undergo bariatric surgery is needed,” Yu said.
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Yu CW, et al. Retinal impacts of bariatric surgery: A meta-analysis of 362,589 patients. Presented at: American Academy of Ophthalmology meeting; Nov. 12-15, 2021; New Orleans.
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