Progression of Diabetic Retinopathy After Bariatric Surgery

Diabet Med. 2015 Sep;32(9):1212-20. doi: 10.1111/dme.12727. Epub 2015 Feb 26.

Abstract

Aim: To assess the impact of bariatric surgery on the progression of diabetic retinopathy in patients with Type 2 diabetes.

Method: We conducted a retrospective, observational study of patients with Type 2 diabetes who underwent bariatric surgery between 1 January 2001 and 31 December 2012 and had hospital-based retinal screening records. Data were collected from four surgical centres. Those who had pre-operative retinal screening and at least one post-operative retinal screen were eligible for analysis. A generalized linear mixed model was used to explore significant clinical predictors on the post-operative grade severity over time, controlling for important baseline characteristics.

Results: Three hundred and eighteen patients were eligible for analysis. Of these, 68.6% had no diabetic retinopathy pre-operatively compared with 18.9%, 8.5% and 4% with a diabetic retinopathy grade of minimal, mild or moderate and higher, respectively. First post-operative retinal screening results showed that after surgery 73% had no change in their diabetic retinopathy grade, 11% regressed and 16% progressed. The probability of having a diabetic retinopathy grade of moderate or higher over time post surgery was significantly associated with the magnitude of HbA1c reduction from pre-surgery HbA1c levels, a shorter post-operative retinal screening duration, more severe pre-operative retinal screening grade, male gender and non-Maori/Pacific ethnicity.

Conclusions: A higher pre-operative diabetic retinopathy grade, and a large decrease in HbA1c post surgery warrant closer monitoring of diabetic retinopathy after bariatric surgery. Further prospective, randomized studies are required to investigate the gender and ethnic differences found.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Bariatric Surgery*
  • Diabetes Mellitus, Type 2 / diagnosis
  • Diabetes Mellitus, Type 2 / surgery*
  • Diabetic Retinopathy / diagnosis
  • Diabetic Retinopathy / surgery*
  • Disease Progression
  • Early Diagnosis
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Care
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology
  • Preoperative Care
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome