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Bariatric surgery patients with diabetes less likely to have microvascular disease

Adults with type 2 diabetes who underwent bariatric surgery had lower risk for neuropathy, nephropathy and retinopathy than those who underwent usual care, according to findings recently published in Annals of Internal Medicine.

“Prior studies have shown that most patients who have bariatric procedures experience a remission of their [type 2 diabetes]. However, less is known about whether bariatric surgery reduces risk for incident microvascular disease,” Rebecca O’Brien, MD, of The Permanente Medical Group, Kaiser Permanente Northern California, and colleagues wrote.

Researchers matched 4,024 adults aged 19 years to 79 years with type 2 diabetes who had bariatric surgery in a 3:1 ratio (mean age, 47.6 years) with patients who had usual care (mean age, 48.7 years). The mean BMI in those who had the procedure was 44.9 kg/m² and the mean BMI among those who did not was 43.8 kg/m². Matches were based on age, BMI, diabetes duration, HbA1c level, insulin use, intensity of health care and sex, and all patients were followed for a median of 4.3 years.

O’Brien and colleagues found that those who underwent bariatric surgery had significantly lower risk for incident microvascular disease at 5 years vs. those who underwent usual care (adjusted hazard ratio = 0.41; 95% CI, 0.34-0.48). In addition, patients who underwent bariatric surgery had lower cumulative incidence at 5 years of retinopathy (aHR = 0.55, 95% CI, 0.42-0.73), nephropathy (aHR = 0.41; 95% CI, 0.29-0.58) and diabetic neuropathy (aHR = 0.37; 95% CI, 0.3-0.47).

Researchers wrote that the findings should prompt a discussion among clinicians and their patients who have type 2 diabetes and have a BMI of 35 kg/m² regardless of the patient’s stance on bariatric surgery.

“Our results add to a growing body of evidence suggesting that bariatric surgery not only improves glucose, blood pressure and lipid control but is likely to reduce macrovascular and microvascular complications, as well as improve survival, in patients with severe obesity and [type 2 diabetes],” O’Brien and colleagues wrote.

“The findings from this study should help patients and providers to better understand the potential tradeoffs of bariatric surgery as treatment of [type 2 diabetes] and help them to make more informed decisions about care,” they concluded.”

In a related editorial, Carel W. le Roux, MD, PhD, of the Diabetes Complications Research Centre, at the University College Dublin in Ireland, and Philip R. Schauer, MD, of the Cleveland Clinic Lerner College of Medicine, said the results of this study provide more evidence to support considering bariatric surgery earlier for patients with diabetes.

“For health care policy, these findings imply that bariatric surgery should now be considered an effective [type 2 diabetes] treatment not only to alleviate hyperglycemia but also to prevent the complications that account for the morbidity and mortality of the disease,” they wrote.

“Bariatric surgery can now be intended to prevent complications of [type 2 diabetes]. Bariatric surgery is safe and is, at present, our most evidence-based treatment to put hyperglycemia from [type 2 diabetes] into remission. We are on the verge of having the data to tell our patients with [type 2 diabetes] in the clinic that we can offer them a treatment that significantly reduces the feared complications of this dreadful disease. Surgery should not be a last resort but instead should be used earlier, because prevention is definitely better than cure,” le Roux and Schauer added. – by Janel Miller

Disclosure: O’Brien reports receiving grants from the National Institute of Diabetes and Digestive and Kidney Diseases during the conduct of the study. Please see the study and editorial for all other authors’ relevant financial disclosures.