Progression of diabetic retinopathy after bariatric surgery

Murphy, Rinki; Jiang, Yannan; Booth, Michael; Babor, Richard; MacCormick, Andrew D.; Hammodat, Hisham; Beban, Grant; Barnes, R. M.; Vincent, Andrea L

doi:10.1111/dme.12727

Cited by 50 publications

(62 citation statements)

References 22 publications

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“…Whether individuals with obesity and Type 2 diabetes obtaining diabetes remission after bariatric surgery should continue retinopathy screening has been discussed previously . In our data, only one person in the RYGB group with remission demonstrated deterioration at 6‐year follow‐up, however, in this group no one suffered from previously laser‐treated retinopathy, a feature that might be important when assessing the risk of deterioration . It seems reasonable to continue ophthalmologic screenings, while waiting for stronger data.…”

Section: Discussionmentioning

confidence: 54%

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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Section: Discussionmentioning

confidence: 54%

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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“…Existing data support positive, neutral and negative effects of bariatric surgery on DR . The potential risk factors for DR progression following bariatric surgery may include pre‐operation DR severity, magnitude of post‐surgery HbA1c reduction and, in some cases, gender and ethnicity …”

Section: Early Worsening Following Bariatric Surgerymentioning

confidence: 99%

“…A pilot study in patients with type 2 diabetes and morbid obesity showed that moderate background DR, or worse, increased the risk of DR progression, while minimal DR or the absence of DR resulted in a low incidence of new‐onset DR and DR progression . Findings from a retrospective, observational study in patients with type 2 diabetes showed that the probability of DR progression, to moderate or higher severity, after bariatric surgery was associated with the magnitude of HbA1c reduction from pre‐surgery levels, with a short duration of post‐operative retinal screening, with severe pre‐operative DR, with male gender and with ethnicity …”

Section: Early Worsening Following Bariatric Surgerymentioning

confidence: 99%

Worsening of diabetic retinopathy with rapid improvement in systemic glucose control: A review

Bain

Klufas

et al. 2018

Diabetes Obesity Metabolism

184

101

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Worsening of diabetic retinopathy (DR) is associated with the initiation of effective treatment of glycaemia in some patients with diabetes. It has been associated with risk factors such as poor blood-glucose control and hypertension, and it manifests prior to the long-term benefits of optimizing glycaemic control. The majority of evidence supports an association of large and rapid reductions in blood-glucose levels with early worsening of DR. Despite a general awareness of early worsening within the diabetes community, mechanisms to explain the phenomenon remain speculative. We provide an overview of early worsening of DR and its pathophysiology based on current data. We describe the phenomenon in various settings, including in patients receiving insulin- or non-insulin-based treatments, in those undergoing bariatric surgery, and in pregnant women. We discuss various mechanisms and theories that have been suggested to explain this paradoxical phenomenon, and we summarize the implications of these in clinical practice.

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“…Bariatric surgical procedures can cause prompt and sustained normoglycaemia in up to 80% patients with T2DM and episodes of postoperative reactive hypoglycaemia are not uncommon, making EW of DR a potential concern in this group . Retrospective studies have demonstrated variable effects of bariatric surgery on DR with worsening reported in between 1% and 45% of subjects 1 year after surgery . In a prospective observational study, 13% of patients exhibited progression of DR in the first 12 months post‐operatively, but only 5% of those persisted at 12 months .…”

Section: Discussionmentioning

confidence: 99%

Early worsening of diabetic retinopathy due to intensive glycaemic control

Lim

Wijngaarden

Harper

et al. 2018

Clinical Exper Ophthalmology

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The prevalence of diabetes and diabetic retinopathy is increasing around the world. Glycaemic control is important in reducing the long‐term risk of complications of diabetes, however intensive glycaemic control, particularly in patients with longstanding and poorly controlled diabetes, is associated with the risk of early worsening of diabetic retinopathy and vision loss. We present two clinical cases to illustrate the presentation of early worsening and to highlight a role for intravitreal anti‐vascular endothelial growth factor therapies in ameliorating this phenomenon, as well as a review of the current understanding of this phenomenon. We emphasise the importance of identifying individuals at risk of early worsening of diabetic retinopathy and recommend regular ophthalmological review during the period of intensive glycaemic control to ensure optimal visual outcomes.

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Progression of diabetic retinopathy after bariatric surgery

Abstract: 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.

Cited by 50 publications

References 22 publications

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

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

Worsening of diabetic retinopathy with rapid improvement in systemic glucose control: A review

Early worsening of diabetic retinopathy due to intensive glycaemic control

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