Microvascular Outcomes in Patients With Diabetes After Bariatric Surgery Versus Usual Care: A Matched Cohort Study
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Background: Bariatric surgery improves glycemic control in patients with type 2 diabetes mellitus (T2DM), but less is known about microvascular outcomes. Objective: To investigate the relationship between bariatric surgery and incident microvascular complications of T2DM. Design: Retrospective matched cohort study from 2005 to 2011 with follow-up through September 2015. Setting: 4 integrated health systems in the United States. Participants: Patients aged 19 to 79 years with T2DM who had bariatric surgery (n = 4024) were matched on age, sex, body mass index, hemoglobin A1c level, insulin use, diabetes duration, and intensity of health care use up to 3 nonsurgical participants (n = 11 059). Intervention: Bariatric procedures (76% gastric bypass, 17% sleeve gastrectomy, and 7% adjustable gastric banding) compared with usual care. Measurements: Adjusted Cox regression analysis investigated time to incident microvascular disease, defined as first occurrence of diabetic retinopathy, neuropathy, or nephropathy. Results: Median follow-up was 4.3 years for both surgical and nonsurgical patients. Bariatric surgery was associated with significantly lower risk for incident microvascular disease at 5 years (16.9% for surgical vs. 34.7% for nonsurgical patients; adjusted hazard ratio [HR], 0.41 [95% CI, 0.34 to 0.48]). Bariatric surgery was associated with lower cumulative incidence at 5 years of diabetic neuropathy (7.2% for surgical vs. 21.4% for nonsurgical patients; HR, 0.37 [CI, 0.30 to 0.47]), nephropathy (4.9% for surgical vs. 10.0% for nonsurgical patients; HR, 0.41 [CI, 0.29 to 0.58]), and retinopathy (7.2% for surgical vs. 11.2% for nonsurgical patients; HR, 0.55 [CI, 0.42 to 0.73]). Limitation: Electronic health record databases could misclassify microvascular disease status for some patients. Conclusion: In this large, multicenter study of adults with T2DM, bariatric surgery was associated with lower overall incidence of microvascular disease (including lower risk for neuropathy, nephropathy, and retinopathy) than usual care. Primary Funding Source: National Institute of Diabetes and Digestive and Kidney Diseases.
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Glucose and BP optimization are proven for primary prevention and slowing of nonproliferative retinopathy.
“Optimization of glucose and BP are the proven strategies for primary prevention of diabetic retinopathy and for slowing the progression of preexisting nonproliferative retinopathy.78,185,186,193,522,523”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [522]
The Conclusions (page unavailable) say strict glycemic control is an important factor in preventing progression of diabetic retinopathy. They do not establish BP optimization as a proven strategy or specify primary prevention and slowing of preexisting nonproliferative retinopathy. (LLM, conf=0.86)
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Self-citationAdvances in the management of type 2 diabetes in adults
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Association Between Obesity and Microvascular Diseases in Patients With Type 2 Diabetes Mellitus
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Self-citationBariatric Surgery and Hypertension
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Bariatric Surgery in Cirrhotic Patients: a Matched Case-Control Study
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Obesity and Metabolic Health in CKD
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Self-citationManagement of Diabetes in Patients Undergoing Bariatric Surgery
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Obesity-Related Glomerulopathy: Clinical Management
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Bariatric surgery as a renoprotective intervention
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The Effect of Metabolic Surgery on the Complications of Diabetes: What Are the Unanswered Questions?
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Outcomes of Diabetic Retinopathy Post-Bariatric Surgery in Patients with Type 2 Diabetes Mellitus
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Bariatric surgery for diabetic comorbidities: A focus on hepatic, cardiac and renal fibrosis
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Bariatric Surgery and the Long-Term Risk of Venous Thromboembolism: A Population-Based Cohort Study
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Self-citationLong-term outcomes of bariatric surgery in patients with diabetes
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Stenberg, E., Rask, E., Szabó, É., Näslund, I., & Ottosson, J. (2020) · Obesity Surgery · doi:10.1007/s11695-020-04599-w · Cited by 10 · see citing works
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Comment on: Metabolic surgery improves renal injury independent of weight loss: a meta-analysis
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Adjusting for selection bias due to missing eligibility criteria in emulated target trials
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Self-citationThe evolving role of metabolic and bariatric surgery in contemporary clinical practice
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Diabetes Risk Reduction and Metabolic Surgery
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- Authors
- O'Brien, R., Johnson, E., Haneuse, S., Coleman, K. J., O'Connor, P. J., Fisher, D. P., Sidney, S., Bogart, A., Theis, M. K., Anau, J., Schroeder, E. B., & Arterburn, D.
- Affiliations
- Kaiser Permanente (US)
- Kaiser Permanente Washington Health Research Institute (US)
- Harvard University (US)
- HealthPartners Institute, HealthPartners, Minneapolis, Minnesota (P.J.O.)
- RAND Corporation (US)
- ORCID
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2018-09-04
- Volume
- 169
- Issue
- 5
- Pages
- 300-310
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- PMC
- PMC6759803
- OpenAlex
- W2886418783
- Cited by
- 161
- References
- 62
- Citations by year
- 2026: 10 · 2025: 15 · 2024: 17 · 2023: 13 · 2022: 22 · 2021: 28 · 2020: 28 · 2019: 20 · 2018: 8
- FWCI
- 21.83
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Diabetes and Digestive and Kidney Diseases (K23DK099237, R01DK105960, R01DK092317, P30DK092924)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- bariatric surgery, type 2 diabetes, microvascular complications, diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, gastric bypass, sleeve gastrectomy, gastric banding, usual care, glycemic control, obesity, matched cohort, health care utilization, insulin use, body mass index, integrated health system
- MeSH terms
- Adult, Aged, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Diabetic Nephropathies, Diabetic Neuropathies, Diabetic Retinopathy, Female, Follow-Up Studies, Humans, Male, Microcirculation, Middle Aged, Obesity, Morbid, Retrospective Studies, Risk Factors, Incidence, Proportional Hazards Models, Bariatric Surgery, Young Adult
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