Effect of Bariatric Surgery Versus Intensive Medical Management on Diabetic Ophthalmic Outcomes

Singh, Rishi P.; Gans, Richard; Kashyap, Sangeeta R.; Bedi, Rumneek; Wolski, Kathy; Brethauer, Stacy A.; Nissen, Steven E.; Bhatt, Deepak L.; Schauer, Philip R.

doi:10.2337/dc14-2035

Cited by 29 publications

(25 citation statements)

References 4 publications

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“…In our trial, no significant changes were observed at 2 years after randomization 22 or in the current 5-year analysis (Table S6 in the Supplementary Appendix). In contrast, initial worsening of retinopathy was shown in the Diabetes Control and Complications Trial within the first year of intensive medical treatment.…”

Section: Discussionmentioning

confidence: 60%

“…21 Methods for ophthalmologic evaluations are reported in the protocol. 22 The strategy for all three groups was the adjustment of intensive medical therapy (every 3 months for 2 years and every 6 months thereafter) with the goal of achieving a glycated hemoglobin level of 6.0% or less, without unacceptable side effects associated with medical treatment. Patients in the surgical groups were instructed to take daily supplemental multivitamins, vitamin B 12 , vitamin D, calcium, and iron.…”

Section: Methodsmentioning

confidence: 99%

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Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes

et al. 2017

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BACKGROUND Long-term results from randomized, controlled trials that compare medical therapy with surgical therapy in patients with type 2 diabetes are limited. METHODS We assessed outcomes 5 years after 150 patients who had type 2 diabetes and a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 27 to 43 were randomly assigned to receive intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy. The primary outcome was a glycated hemoglobin level of 6.0% or less with or without the use of diabetes medications. RESULTS Of the 150 patients who underwent randomization, 1 patient died during the 5-year follow-up period; 134 of the remaining 149 patients (90%) completed 5 years of follow-up. At baseline, the mean (±SD) age of the 134 patients was 49±8 years, 66% were women, the mean glycated hemoglobin level was 9.2±1.5%, and the mean BMI was 37±3.5. At 5 years, the criterion for the primary end point was met by 2 of 38 patients (5%) who received medical therapy alone, as compared with 14 of 49 patients (29%) who underwent gastric bypass (unadjusted P = 0.01, adjusted P = 0.03, P = 0.08 in the intention-to-treat analysis) and 11 of 47 patients (23%) who underwent sleeve gastrectomy (unadjusted P = 0.03, adjusted P = 0.07, P = 0.17 in the intention-to-treat analysis). Patients who underwent surgical procedures had a greater mean percentage reduction from baseline in glycated hemoglobin level than did patients who received medical therapy alone (2.1% vs. 0.3%, P = 0.003). At 5 years, changes from baseline observed in the gastric-bypass and sleeve-gastrectomy groups were superior to the changes seen in the medical-therapy group with respect to body weight (−23%, −19%, and −5% in the gastric-bypass, sleeve-gastrectomy, and medical-therapy groups, respectively), triglyceride level (−40%, −29%, and −8%), high-density lipoprotein cholesterol level (32%, 30%, and 7%), use of insulin (−35%, −34%, and −13%), and quality-of-life measures (general health score increases of 17, 16, and 0.3; scores on the RAND 36-Item Health Survey ranged from 0 to 100, with higher scores indicating better health) (P<0.05 for all comparisons). No major late surgical complications were reported except for one reoperation. CONCLUSIONS Five-year outcome data showed that, among patients with type 2 diabetes and a BMI of 27 to 43, bariatric surgery plus intensive medical therapy was more effective than intensive medical therapy alone in decreasing, or in some cases resolving, hyperglycemia.

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Section: Discussionmentioning

confidence: 60%

Section: Methodsmentioning

confidence: 99%

Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes

et al. 2017

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“…There have been a number of much smaller studies that have also shown the impact of bariatric surgery on the reduction in risk of retinopathy in patients with type 2 diabetes (21–25), although the STAMPEDE (Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently) trial found no improvement in retinopathy outcomes with surgery after 2 years of follow-up (26). Our study is the largest to date supporting the impact of bariatric surgery on reduction in risk for retinopathy up to 7 years postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Long-term Microvascular Disease Outcomes in Patients With Type 2 Diabetes After Bariatric Surgery: Evidence for the Legacy Effect of Surgery

et al. 2016

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OBJECTIVETo identify and quantify any legacy effect of bariatric surgery on risk of incident microvascular disease in patients with type 2 diabetes.RESEARCH DESIGN AND METHODSWe conducted a retrospective observational cohort study (n = 4,683; 40% racial/ethnic minority) of patients with type 2 diabetes who underwent bariatric surgery from 2001 through 2011. The primary outcome measure was incident microvascular disease defined as a composite indicator of the first occurrence of retinopathy, neuropathy, and/or nephropathy. The Cox proportional hazards framework was used to investigate the associations between type 2 diabetes remission/relapse status and time to microvascular disease.RESULTSCovariate-adjusted analyses showed that patients who experienced type 2 diabetes remission had 29% lower risk of incident microvascular disease compared with patients who never remitted (hazard ratio [HR] 0.71 [95% CI 0.60, 0.85]). Among patients who experienced a relapse after remission, the length of time spent in remission was inversely related to the risk of incident microvascular disease; for every additional year of time spent in remission prior to relapse, the risk of microvascular disease was reduced by 19% (HR 0.81 [95% CI 0.67, 0.99]) compared with patients who never remitted.CONCLUSIONSOur results indicate that remission of type 2 diabetes after bariatric surgery confers benefits for risk of incident microvascular disease even if patients eventually experience a relapse of their type 2 diabetes. This provides support for a legacy effect of bariatric surgery, where even a transient period of surgically induced type 2 diabetes remission is associated with lower long-term microvascular disease risk.

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“…However, improvement in albuminuria after surgery (RYGB, 64% decrease, P = 0.04) was noted by Schauer et al (31) in the Surgical Therapy And Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial at 3 years despite a reduction in renin-angiotensin-aldosterone system blockers, suggesting that bariatric surgery may have a role in the prevention of further parenchymal damage. In addition, the STAMPEDE trial demonstrated that bariatric surgery (RYGB or SG) did not appear to worsen or improve retinopathy outcomes at 2 years compared with intensive medical management ( P = 0.84), and a majority, 86.5%, of patients within all treatment groups had no change in retinopathy scoring (44). Additionally, there was no significant change in LogMAR visual acuity from baseline among the treatment arms ( P > 0.05), as the mean baseline and 2-year visual acuity were the same in all three groups (LogMAR 0, Snellen equivalent 20/20).…”

Section: Rcts Of Metabolic Surgerymentioning

confidence: 99%

Clinical Outcomes of Metabolic Surgery: Efficacy of Glycemic Control, Weight Loss, and Remission of Diabetes

et al. 2016

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Since the 2007 Diabetes Surgery Summit in Rome, Italy, and the subsequent publishing of the world’s first guidelines for the surgical treatment of type 2 diabetes (T2D), much new evidence regarding the efficacy and safety of metabolic surgery has emerged. Additional observational cohort studies support the superior effects of surgery over medical treatment with respect to glycemic control, weight loss, and even reduction in mortality and microvascular complications associated with T2D. Furthermore, new safety data suggest that the perioperative morbidity and mortality of metabolic surgery (5% and 0.3%, respectively) are now similar to that of common low-risk procedures, such as cholecystectomy and hysterectomy. The largest advance, however, has been the completion of 11 randomized controlled trials from around the globe that compare surgery with medical treatment of T2D. These studies with follow-up duration of 1–5 years involve nearly 800 patients without surgical mortality and with major complication rates of less than 5% and a reoperation rate of 8%. All but 1 of the 11 randomized controlled trials have shown the superiority of surgery over medical management at achieving remission or glycemic improvement. Surgery was also superior to medical treatment with respect to improving cardiovascular risk factors, such as weight loss and dyslipidemia, while reducing medication burden. This new efficacy and safety evidence should help guide physicians across the globe to the appropriate use of surgery as an effective treatment for patients suffering from T2D and obesity.

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Effect of Bariatric Surgery Versus Intensive Medical Management on Diabetic Ophthalmic Outcomes

Cited by 29 publications

References 4 publications

Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes

Bariatric Surgery versus Intensive Medical Therapy for Diabetes — 5-Year Outcomes

Long-term Microvascular Disease Outcomes in Patients With Type 2 Diabetes After Bariatric Surgery: Evidence for the Legacy Effect of Surgery

Clinical Outcomes of Metabolic Surgery: Efficacy of Glycemic Control, Weight Loss, and Remission of Diabetes

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