The impact of bariatric surgery on retinopathy in patients with type 2 diabetes: A retrospective cohort study

Research output: Contribution to journalArticle

Authors

  • Amin Mamoon Amin
  • Helen Wharton
  • Margaret Clarke
  • Ateeq Syed
  • Paul Dodson

External organisations

  • Centre of Endocrinology
  • Department of Diabetes and Endocrinology
  • Birmingham Heartlands Hospital, Birmingham, UK.
  • St. George's Healthcare National Health Service Trust

Abstract

Background The impact of bariatric surgery on diabetic retinopathy (DR) is unclear. DR might improve after surgery because of improvement in DR risk factors, but the rapid improvement in hyperglycemia after surgery could worsen DR. Objectives To assess the impact of bariatric surgery on the progression to sight-threatening DR (STDR) in patients with type 2 diabetes mellitus (T2DM) and compare STDR progression in patients with T2DM who underwent bariatric surgery with a group of matched patients receiving routine care between January 2005 and December 2012 at a single center. Setting Single-center university hospital. Methods DR was assessed using 2×45-degree retinal images obtained from the English National Diabetic Eye Screening Programme. Only patients who had retinal images within 1 year before surgery and at least 1 image after surgery were included in the analysis. STDR was defined as the presence of preproliferative/proliferative DR, maculopathy, or laser treatment. The comparator group comprised patients with T2DM who attended the same center for diabetes care and who had not undergone bariatric surgery. Results This analysis comprised 152 patients (mean age, 50.7±8.2 yr; baseline body mass index, 49.0±7.3 kg/m2) who were followed-up for 3.0±1.9 years. Of the 141 patients without STDR at baseline, 8 (5.7%) developed STDR by the end of the study. Of 106 patients with no DR at baseline, 2 (1.9%) developed preproliferative DR. Of 41 patients with background DR at baseline, 5 (12.2%) developed preproliferative DR. Of the 143 patients with no maculopathy at baseline, 8 (5.6%) developed maculopathy. Compared with a matched group for age, glycated hemoglobin, and follow-up duration, the progression to STDR and maculopathy was less in patients who underwent surgery versus those who received routine care (STDR: 5.7% [8/141] versus 12.1% [12/99], P =.075; maculopathy: 5.6% [8/143] versus 15.4% [16/104], P =.01, respectively). Conclusions After bariatric surgery, patients with T2DM remain at risk for developing STDR, even those who did not have evidence of DR before surgery. However, surgery was associated with a lower progression to STDR or maculopathy compared with routine care. Randomized clinical trials are needed to ascertain the impact of bariatric surgery on DR.

Details

Original languageEnglish
Pages (from-to)606-612
Number of pages7
JournalSurgery for Obesity and Related Diseases
Volume12
Issue number3
Early online date29 Aug 2015
Publication statusPublished - 1 Mar 2016

Keywords

  • Bariatric surgery, Maculopathy, Obesity, Sight threatening diabetic retinopathy, Type 2 diabetes mellitus

ASJC Scopus subject areas