Type 2 diabetes mellitus and microvascular complications 1 year after Roux-en-Y gastric bypass: a case–control study

Abstract

Aims/hypothesisWe aimed to examine the effects of bariatric surgery on microvascular complications in patients with type 2 diabetes using objective measures.MethodsProspective case–control study of 70 obese surgical patients with type 2 diabetes undergoing gastric bypass surgery matched for age, sex and duration of diabetes to 25 medical patients treated using international guidelines. Microvascular complications were assessed before and 12–18 months after intervention using urine albumin creatinine ratio (ACR) measurements, two-field digital retinal images and peripheral nerve conduction studies (in the surgical group only).ResultsUrine ACR decreased significantly in the surgical group but increased in the medical group. There were no significant differences between the surgical and medical groups in the changes in retinopathy. There were no changes in the nerve conduction variables in the surgical group.Conclusions/interpretationIn the short term, bariatric surgery may be superior to medical care in the treatment of diabetic nephropathy, but not retinopathy or neuropathy.

Why the NHS should do more bariatric surgery; how much should we do?:

“…4 10 Alternatively, priority might be given to people with established microvascular complications because despite best pharmacological care many will become increasingly unwell and require more expensive treatment. 36 Another option is for the multidisciplinary team to decide based on individual need-for instance, a patient with sleep apnoea falling asleep at work or needing urgent weight loss before kidney transplantation. 28…”

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“…Evidence shows that 6 months after a gastric bypass, there is a significant reduction in the expression of mRNA linked to APP, presenilin-2, ADAM-9, GSK-3B, PICALM, SORL-1 and clusterin besides an important clinical improvement of cognitive capabilities of patients who have undergone bariatric surgery [42]. Patients that undergo gastric bypass have a reduced risk of coronary disease, peripheral angiopathy, stroke, diabetic nephropathy, peripheral neuropathy [43,44] as well as diabetic retinopathy [45]. In the case of nephropathy [46], an improvement on the tissular damage and overall function markers has been observed, which has allowed for replacement therapy to be interrupted or delayed temporarily [47].…”

Measuring changes in renal function after bariatric surgery: Why estimated glomerular filtration rate is not good enough

“…Measuring renal function after bariatric surgery is gaining increasing interest because of the emergence of reports detailing reductions in renal damage after surgery but lacking conclusive evidence pointing to coherent improvements in renal function [1]. Mirajkar et al Q3 .…”