People with type 2 diabetes and obesity who undergo bariatric (weight-loss) surgery are at lower risk for diabetic retinopathy (eye disease), according to new research presented at the 2021 meeting of the American Academy of Ophthalmology in New Orleans, and described in an article at Healio.
For people with type 2 diabetes who qualify for bariatric surgery, the procedure has been linked to improved health in multiple areas. Just in the last few weeks, a major study was published showing that bariatric surgery is linked to a lower risk for cancer in people with type 2 diabetes. The surgery is also linked to lower levels of liver fat and improved pregnancy outcomes in people with type 2. And as a large body of research now shows, for some people, bariatric surgery leads to lasting remission of type 2 diabetes — leading to normal blood glucose levels without the need for insulin or other glucose-lowering medications. Even for people who don’t experience diabetes remission after bariatric surgery, the procedure can improve perceived health and quality of life.
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For the latest analysis, researchers looked at data from 14 different studies that involved people with type 2 diabetes undergoing bariatric surgery. Overall, there were 362,589 participants, with some people undergoing bariatric surgery and others serving as a control group that underwent standard “medical management” of their obesity. The researchers were interested in the link between bariatric surgery and the number of cases of diabetic retinopathy overall, as well as cases of “sight-threatening” diabetic retinopathy (defined as proliferative or preproliferative diabetic retinopathy, diabetic maculopathy, or severe nonproliferative diabetic retinopathy). They also looked at whether people who already had retinopathy prior to bariatric surgery saw the condition get worse within 12 months after the surgery, as well as after that point.
Rate of retinopathy lower in those who had bariatric surgery
The researchers found that after a median follow-up period of eight years, the prevalence of diabetic retinopathy was 0.45% in people who underwent bariatric surgery, and 1.03% in people who didn’t have the surgery — meaning that the rate of diabetic retinopathy was 53% lower in people who had bariatric surgery. People who underwent bariatric surgery were also significantly less likely to have sight-threatening retinopathy after a median follow-up period of four years. Among people who had diabetic retinopathy before undergoing bariatric surgery, the surgery did little to slow the worsening of retinopathy within the first 12 months after the surgery. But after that, after a median follow-up period of five years, people who underwent bariatric surgery were significantly less likely to experience progression of their retinopathy. Still, 8% of people who had bariatric surgery saw their retinopathy progress between two and 13 years after their surgery.
The researchers noted that these results support bariatric surgery as potential way to help reduce the risk for retinopathy in people with type 2 diabetes and obesity — and also show the importance of early screening for retinopathy. For people who already had longstanding or advanced retinopathy before the procedure, bariatric surgery was less effective at halting the progression of this vision-threatening condition.
Want to learn more about bariatric surgery and type 2 diabetes? Read “Is Bariatric Surgery for You?” and “Bariatric Surgery and Diabetes: Questions and Answers.”