Microvascular complications of obesity and diabetes—Role of bariatric surgery

Abstract

SummaryBariatric surgery in people with obesity can lead to long‐term remission of type 2 diabetes mellitus (T2DM) and a reduction in the incidence of macrovascular complications. The impact of bariatric surgery on microvascular complications is less clear. In this narrative review, we sought to evaluate the effect of bariatric surgery on microvascular complications in patients with and without diabetes. The risk of developing microvascular complications is increased in people with obesity, and this is amplified in those with T2DM. The impact of metabolic surgery on microvascular complications is limited to a subgroup analysis of studies or statistical modeling to predict the glycemia‐independent effect of bariatric surgery. While bariatric surgery halts the progression of retinopathy in those with minimal retinopathy, it may worsen in those with advanced retinopathy. Bariatric surgery improves proteinuria and major renal outcomes, regardless of the severity of renal impairment. Bariatric surgery in patients with obesity with or without diabetes is associated with an improvement in neuropathic symptoms and regeneration of small nerve fibers. In conclusion, bariatric surgery is associated with an improvement in microvascular complications. Further studies are needed to elucidate the underlying mechanisms for the favorable effect of bariatric surgery on microvascular outcomes.

Weight Loss Following Bariatric Surgery in People with or without Metabolic Syndrome: A 5-Year Observational Comparative Study

“…Bariatric surgery is well established as a highly effective intervention in chronic severe obesity, leading to the resolution of comorbidities associated with obesity such as T2D, hypertension, hyperlipidaemia, OSA, and microvascular disease, as well as a reduction in mortality in patients over the long term [ 8 , 17 , 18 ]. The prospective Swedish Obese Subjects study concluded that bariatric surgery was superior to conventional treatment in terms of reduction in mortality and beneficial effects on comorbidities [ 19 ].…”

Changes in Serum Urate Levels after Bariatric Surgery in Patients with Obesity: An Observational Study

“…Bariatric surgery, the most effective and durable weight loss intervention, reduces rates of metabolic and obesityassociated diseases [9,10]. However, bariatric surgery has been associated with temporarily increased serum uric acid levels and gout attacks in the immediate postoperative period in a study of 60 patients with type 2 diabetes undergoing sleeve gastrectomy [11], and another study of 99 patients with pre-existing gout who underwent bariatric surgery compared to patients undergoing non-surgical weight management [12].…”

Causal relationship between T2DM microvascular complications and gut microbiota: a Mendelian randomization study

“…Microvascular complications of type 2 diabetes mellitus(T2DM) refer to the complications arising from structural and functional changes in the microvasculature in T2DM. These include T2DM retinopathy, T2DM neuropathy, and T2DM nephropathy ( 1 , 2 ). As the specific pathogenesis of microvascular complications in T2DM is not yet clear, and the onset of these complications is often insidious, they are typically diagnosed at a more advanced stage in clinical settings.…”