Bariatric Surgery and Diabetic Retinopathy: a Pilot Analysis

Varadhan, Lakshminarayanan; Humphreys, Tracy; Walker, Adrian B; Cheruvu, Chandra; Varughese, George

doi:10.1007/s11695-012-0600-9

Cited by 46 publications

(34 citation statements)

References 7 publications

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“…In those subjects who did not have preoperative DR, 92.5 ± 7.4% remained disease free at followup and 7.5 ± 7.4% developed DR. These data are supported by a further smaller study looking at retinopathy [44].…”

Section: Effects On Microvascular Complicationssupporting

confidence: 71%

The effect of bariatric surgery on obesity and its complications

Azmi¹,

Alam²,

Ammori³

et al. 2015

Diabetes Management

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Obesity has become a worldwide epidemic that is accompanied by a rise in Type 2 diabetes mellitus. Management of obesity is paramount to prevent the associated mortality and morbidity. Several randomized control trials show that bariatric surgery is an effective method for the treatment of obesity and remission of Type 2 diabetes in the short term. Long-term observational studies have further validated the improvements in weight and Type 2 diabetes as well as cardiovascular events and overall mortality. There is an improvement in microvascular outcomes, in particular retinopathy and nephropathy show promising results but further studies are needed to evaluate hard-end points for neuropathy. Bariatric surgery is cost effective with the cost of surgery being offset by future cost benefits. KEYWORDS Practice points• There is a worldwide increase in obesity and Type 2 diabetes mellitus (T2DM).• Obesity is associated with increased mortality and morbidity.• Bariatric Surgery is a cost-effective treatment for obesity and Type 2 diabetes, which in the long-term is associated with an improvement in mortality.• NICE guidelines recommend that all patients with a BMI of 35 or over who have recent-onset T2DM be assessed for bariatric surgery.• The outcome on weight of the different surgical procedures affects the remission rates of T2DM.• Microvascular outcomes show promising results postbariatric surgery, however, these need to be further evaluated particular on neuropathy.• Careful patient selection is important to achieve the best outcomes post bariatric surgery.There is a worldwide rapid increase in obesity prevalence such that it may be described as an epidemic. Obesity has more than doubled since 1980 such that in 2014 more than 1.9 billion adults were overweight and over 600 million were obese [1]. In 2013, 42 million children under the age of 5 years were overweight or obese [1]. The adverse consequences of this are emphasized when one considers that BMI is a powerful predictor of Type 2 diabetes mellitus (T2DM), cardiovascular (CV) morbidity and mortality [2,3]. There are currently 382 million people in the world with diabetes and this is estimated to reach 592 million by 2035 [4]. Indeed despite the emphasis on malnutrition in the developing world, overweight and obesity are linked to more deaths than being underweight.For reprint orders, please contact: reprints@futuremedicine.com

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Section: Effects On Microvascular Complicationssupporting

confidence: 71%

The effect of bariatric surgery on obesity and its complications

Azmi¹,

Alam²,

Ammori³

et al. 2015

Diabetes Management

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show abstract

“…The effect of bariatric surgery on diabetic retinopathy is not yet fully defined but appears to be unpredictable and may even be associated with worsening of existing diabetic retinopathy after surgery [42, 43]. …”

Section: Introductionmentioning

confidence: 99%

The Role of Systemic Risk Factors in Diabetic Retinopathy

Atchison

Barkmeier

2016

Curr Ophthalmol Rep

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Diabetic retinopathy is an increasingly common medical issue in the United States. The risk of developing the disease or having the disease progress is caused by many systemic health factors. This article examines the existing literature on the links between glycemic control, arterial hypertension, high cholesterol and hyperlipidemia, obesity, inflammatory markers, sleep-disordered breathing, and exercise with risk of diabetic retinopathy development and prevention. The literature shows benefit for good glycemic and blood pressure control. The effects of cholesterol, and lipid control, inflammatory markers, sleep-disordered breathing, obesity, and exercise are less well established.

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“…On the contrary, short term benefits in DR may be masked if metabolic memory is playing a role [20]. Previous studies have demonstrated these variable progressions of DR after bariatric surgery in short and long term [5][6]. Our study again demonstrates the variable nature of progression of DR following bariatric surgery and the difficulties in predicting the direction of progression of DR after bariatric surgery.…”

Section: Discussionmentioning

confidence: 48%

“…It has previously been published that changes in DR following bariatric surgery have been unpredictable [5]. Recently published studies, comparing routine T2DM clinical care against bariatric Course of Diabetic retinopathy following bariatric surgery in patients with Type 2 diabetes: the immediate and late impact of glycaemic control surgery, had shown that a small but significant proportion of patients could develop sight threatening DR or maculopathy [6].…”

Section: Introductionmentioning

confidence: 99%

Course of Diabetic retinopathy following bariatric surgery in patients with Type 2 diabetes: the immediate and late impact of glycaemic control

Varadhan¹,

Kalidindi²,

Gill³

et al. 2017

Integr Obesity Diabetes

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Background: Diabetic Retinopathy (DR) is a significant complication of diabetes mellitus, which can worsen during rapid fluctuations in glycaemic control. Bariatric surgery can cause sudden improvement in diabetes control which can affect DR in the short term.Objectives: To assess the immediate and late impact of bariatric surgery on DR status in patients with type 2 diabetes mellitus and to evaluate the need for continuing retinal screening despite improvement or remission of diabetes. Methods:A retrospective clinical observational analysis was conducted on patients who underwent bariatric surgery for type 2 diabetes. One-year pre-operative and all post-operative retinal screen images were obtained and graded using the national diabetic eye screen programme grading. Conclusion:Our study demonstrates the variable nature of progression of DR after bariatric surgery in patients with type 2 diabetes mellitus. Long term trials are needed to identify the pattern of progression and to identify risk factors.

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Bariatric Surgery and Diabetic Retinopathy: a Pilot Analysis

Cited by 46 publications

References 7 publications

The effect of bariatric surgery on obesity and its complications

The effect of bariatric surgery on obesity and its complications

The Role of Systemic Risk Factors in Diabetic Retinopathy

Course of Diabetic retinopathy following bariatric surgery in patients with Type 2 diabetes: the immediate and late impact of glycaemic control

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