Bariatric Surgery Reduces Incidence of Microvascular Disease in Type 2 Diabetes

Investigators examined the effect of bariatric surgery and the incidence of microvascular complications in type 2 diabetes.

Bariatric surgery in type 2 diabetes (T2D) was associated with half the incidence of microvascular disease at 5 years, including a lower incidence of nephropathy and retinopathy, compared with medical care, according to findings published in the Annals of Internal Medicine.

Studies have established that bariatric surgery can improve glycemic control in patients with T2D but the effect on microvascular outcomes is unclear. In the current paper, researchers examined the relationship between bariatric surgery and incident microvascular complications of T2D in a retrospective cohort study that included 4024 adult participants with T2D. All participants with T2D had undergone bariatric surgery and were matched with a control group who had not had the procedure. The median follow-up was 4.3 years in both groups.

At 1, 3, 5, and 7 years, the rates of incident microvascular disease were 6.0%, 11.8%, 16.9%, and 22.5%, respectively, after bariatric surgery compared with 11.2%, 24.3%, 34.7%, and 44.2%, respectively, after usual medical care. This difference was primarily driven by the incidence of neuropathy, which was lower in patients who had undergone bariatric surgery. The cumulative incidence rates of nephropathy were similar in the bariatric surgery and control groups (2.7% and 2.8%, respectively) during the first year after surgery, but the rates declined thereafter for all time points after 1 year. Rates of retinopathy were also lower in patients who had undergone surgery.

“Our results add to a growing body of evidence suggesting that bariatric surgery not only improves glucose, blood pressure, and lipid control but is likely to reduce macrovascular and microvascular complications, as well as improve survival, in patients with severe obesity and [T2D],” wrote the investigators.

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O’Brien R, Johnson E, Haneuse S, et al. Microvascular outcomes in patients with diabetes after bariatric surgery versus usual care: a matched cohort study [published online August 7, 2018]. Ann Intern Med. doi:10.7326/M17-2383