Bariatric surgery is associated with less progression of diabetic retinopathy: A systematic review and meta-analysis

Kim, Yong Joon; Kim, Byoung Hyuck; Choi, Bo Mi; Sun, Hae Jung; Lee, Sung‐Jin; Choi, Kyung Seek

doi:10.1016/j.soard.2016.10.002

Cited by 28 publications

(28 citation statements)

References 48 publications

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“…In particular for patients with no or early DR, the level of DR is often stable or improved after surgery (Cheung et al 2015;Brynskov et al 2016;Kim et al 2017). Remission of diabetes is achieved for most patients.…”

Section: Bariatric Surgerymentioning

confidence: 99%

Evidence‐based Danish guidelines for screening of diabetic retinopathy

Grauslund

Andersen

Andresen

et al. 2018

Acta Ophthalmologica

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Purpose: Diabetic retinopathy (DR) is among the leading causes of visual loss in the working-age population. It is generally accepted that screening of DR is costeffective and can detect DR before it becomes sight-threatening to allow timely treatment. Methods: A group of retinal specialists was formed by the Danish Ophthalmological Society with the aim to formulate contemporary evidence-based guidelines for screening of DR in order to implement these in the Danish screening system. Results: We hereby present evidence for DR-screening regarding (1) classification of DR, (2) examination techniques, (3) screening intervals and (4) automated screening. It is our recommendation that the International Clinical Retinopathy Disease Severity Scale should be used to classify DR. As a minimum, mydriatic two-field disc-and macular-centred images are required. In the case of suspected clinically significant diabetic macular oedema, supplementary optical coherence tomography can increase the diagnostic accuracy. There is solid evidence to support a flexible, individualized screening regimen. In particular, it is possible to prolong screening intervals to 24-48 months for patients with no or mild nonproliferative diabetic retinopathy (NPDR), but it is also possible to use extended intervals of 12-24 months for patients with moderate NPDR given that these are well-regulated regarding glycaemic control (HbA1c ≤ 53 mmol/mol) and blood pressure (≤130/80 mmHg). Automated screening of DR is encouraging but is not ready for implementation at present. Conclusion: Danish evidenced-based guidelines for screening of DR support high-quality imaging and allow flexible, individualized screening intervals with a potential for extension to patients with low risk of DR progression.

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Section: Bariatric Surgerymentioning

confidence: 99%

Evidence‐based Danish guidelines for screening of diabetic retinopathy

Grauslund

Andersen

Andresen

et al. 2018

Acta Ophthalmologica

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“…However, because the improvement in blood glucose regulation has an immediate onset, the concern of 'early worsening' in retinopathy also applies to RYGB [11]. Previous studies assessing the effect of bariatric surgery on retinopathy have been limited by the inclusion of several or unspecified types of bariatric surgery [10,[12][13][14][15][16][17], an absence of non-operated controls [12][13][14][18][19][20], or a lack of information about diabetes duration, surgical diabetes remission, blood pressure, HbA 1c , smoking or BMI. A recent review of the few controlled trials available, concluded that bariatric surgery prevents new cases of retinopathy, but more long-term data are needed to conclude more convincingly concerning the development of retinopathy [21].…”

Section: Introductionmentioning

confidence: 99%

Diabetic retinopathy in people with Type 2 diabetes and obesity treated by Roux‐en‐Y gastric bypass compared with non‐operated controls: with focus on the role of diabetes remission in a cross‐sectional and a 6‐year follow‐up study

2018

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Aim Whether or not Roux‐en‐Y gastric bypass (RYGB) and the derived metabolic improvements are beneficial to diabetic retinopathy is controversial. We aimed to determine the presence and development of retinopathy in individuals with obesity and Type 2 diabetes treated by RYGB compared with non‐operated controls, and to determine the role of diabetes remission. Methods We graded fundus photography using the Wisconsin Epidemiologic Study of Diabetic Retinopathy in 96 individuals with obesity and Type 2 diabetes treated by RYGB 6 years after surgery compared with 48 non‐operated controls. In a subsample, we investigated the development of retinopathy over time. In the secondary analysis, we divided the RYGB group according to diabetes remission. Results RYGB surgery was not statistically associated with less retinopathy [relative risk (RR) 0.82, 95% CI 0.59 to 1.14], when adjusted for diabetes duration, sex, age and BMI. During 5.9 years of follow‐up, retinopathy grading in the RYGB group was unchanged, whereas the control group displayed worse grading by 0.69 steps (95% CI 0.18 to 1.19). The RYGB group with diabetes remission (52%) showed a trend towards less retinopathy [adjusted RR (aRR) 0.45; 95% CI 0.19 to 1.06] than controls, and less retinopathy (aRR 0.33; 95% CI 0.11 to 0.94) than the RYGB group without remission in the cross‐sectional data. Conclusions In a cross‐sectional setting, individuals with Type 2 diabetes treated by RYGB showed a tendency towards less retinopathy than non‐operated controls, in particular diabetes remission following RYGB was associated with less retinopathy. Moreover after 5.9 years, retinopathy in the RYGB group had progressed less than in the control group. (Clinical Trial Registry No: NCT02625649)

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“…The Korean group reviewed twelve studies composed of 876 patients with T2DM who underwent bariatric surgery. This review noted that remission of diabetes couldn't prevent the development or progression of DR after surgery [8]. A further systematic review and meta-analysis of controlled clinical studies was done by an Italian group to compare the rate of appearance and progression/regression of DR in studies comparing medical and surgical treatment of T2DM [9].…”

Section: Discussionmentioning

confidence: 99%

“…Though it is generally believed that bariatric surgery would have a favourable impact on progression of sight threatening DR, patients can get transient worsening of DR especially in the first year following surgery [6]. Three separate systematic review's and meta-analysis published on the impact of bariatric surgery on diabetic retinopathy have also concurred that available studies are not sufficient to support progression or regression of retinopathy [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Course of Diabetic retinopathy following bariatric surgery in patients with Type 2 diabetes: the immediate and late impact of glycaemic control

Varadhan¹,

Kalidindi²,

Gill³

et al. 2017

Integr Obesity Diabetes

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Background: Diabetic Retinopathy (DR) is a significant complication of diabetes mellitus, which can worsen during rapid fluctuations in glycaemic control. Bariatric surgery can cause sudden improvement in diabetes control which can affect DR in the short term.Objectives: To assess the immediate and late impact of bariatric surgery on DR status in patients with type 2 diabetes mellitus and to evaluate the need for continuing retinal screening despite improvement or remission of diabetes. Methods:A retrospective clinical observational analysis was conducted on patients who underwent bariatric surgery for type 2 diabetes. One-year pre-operative and all post-operative retinal screen images were obtained and graded using the national diabetic eye screen programme grading. Conclusion:Our study demonstrates the variable nature of progression of DR after bariatric surgery in patients with type 2 diabetes mellitus. Long term trials are needed to identify the pattern of progression and to identify risk factors.

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Bariatric surgery is associated with less progression of diabetic retinopathy: A systematic review and meta-analysis

Cited by 28 publications

References 48 publications

Evidence‐based Danish guidelines for screening of diabetic retinopathy

Evidence‐based Danish guidelines for screening of diabetic retinopathy

Diabetic retinopathy in people with Type 2 diabetes and obesity treated by Roux‐en‐Y gastric bypass compared with non‐operated controls: with focus on the role of diabetes remission in a cross‐sectional and a 6‐year follow‐up study

Course of Diabetic retinopathy following bariatric surgery in patients with Type 2 diabetes: the immediate and late impact of glycaemic control

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