1. Patients who received gastric bypass surgery had lower rates of diabetic neuropathy at follow up that remained stable throughout the study.
2. Bariatric surgery was associated with lower rates of diabetic retinopathy compared to usual care.
Evidence Rating Level: 2 (Good)
Study Rundown: Bariatric surgery has been shown to have significant effects on glycemic control in various settings, including type 2 diabetes mellitus (T2DM). The authors of this study aimed to evaluate the relationship between microvascular procedures and microvascular complications of T2DM. Bariatric procedures included gastric bypass, sleeve gastrectomy, and adjustable gastric banding. In general, it was found that bariatric surgery was linked to significant reduction in microvascular complications of T2DM. This study had several limitations. First, as electronic health records were utilized for data collection, it is possible that some microvascular complications were misclassified. Further, the authors stated that they had not adjusted for clinical center within study site due to methodology limitations.
In-Depth [retrospective cohort]: The authors conducted a retrospective matched cohort study consisting of four integrated health systems in the United States from 2005 to 2011. In total, the final sample consisted of 4024 T2DM surgical patients and 11 059 nonsurgical matches. The authors utilized an adjusted Cox regression analysis to assess time to incident microvascular disease; this outcome was defined as the first presentation of diabetic retinopathy, neuropathy, or nephropathy. During the study period, 76% of the surgical patients had a gastric bypass, with 17% having a sleeve gastrectomy and 7% the adjustable gastric banding. It was found that the HR for all microvascular events decreased following the index date. For example, risk of nephropathy ultimately decreased among surgical patients from years 1 through 7. At the five-year point, bariatric surgery was associated with lower risk of incident microvascular disease (16.9% for surgical vs. 34.7% for nonsurgical patients; HR 0.41 [95% CI, 0.34 to 0.48]).
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