Bariatric surgery prevents microvascular complications in T2D

Bariatric surgery not only improves glycaemia in patients with type 2 diabetes (T2D), it also reduces microvascular complications by about half, a US study shows.

A retrospective review of 4024 patients with T2D who underwent bariatric surgery found that their risk of diabetic neuropathy, retinopathy and nephropathy was reduced by 59% in five years of follow up compared to matched control group of 11,059 patients who received usual diabetes care.

The study, carried out at four centres in the US, found that bariatric surgery was associated with significantly lower risk for incident microvascular disease at five years (16.9% vs. 34.7%) compared to non-surgical management, with an adjusted hazard ratio, of 0.41.

Patients who underwent bariatric surgery had a lower cumulative incidence of diabetic neuropathy (7.2% vs 21.4%, HR 0.37), nephropathy (4.9% vs 10% HR 0.41) and retinopathy (7.2% vs 11.2% HR 0.55) compared to non-surgical patients.

Most of the patients who underwent bariatric surgery were middle-aged women, with 27% having a BMI of 35-40 and 52% having a BMI of 40-50 kg/m2.

The study authors said their findings added to those of other smaller studies showing that the benefits of bariatric surgery go beyond weight loss and glycaemia and translate into long term improvements in clinical outcomes that matter for obese patients with T2D.

“Not all patients will be interested in bariatric surgery to treat their T2D, but providers should engage all patients with T2DM and a BMI of 35 kg/m2 or higher in a shared decision-making conversation about the benefits and risks of bariatric procedures,” they suggest.

An accompanying commentary goes further and says the findings show that bariatric surgery can be considered as a treatment that “fundamentally changes the course” of type 2 diabetes.

“Such a remarkable decrease in microvascular complications has rarely been shown by any form of diabetes therapy,” says the article co-authored by Professor Carel le Roux of the Diabetes Complications Research Centre at University College, Dublin.

“For health care policy, these findings imply that bariatric surgery should now be considered an effective T2DM treatment not only to alleviate hyperglycemia but also to prevent the complications that account for the morbidity and mortality of the disease.”

His commentary cautions that the benefits on microvascular complications need to be confirmed in randomised controlled trials, but says the benefits may be even greater in bariatric surgery patients who also receive fenofibrate and ACE inhibitors.

“Surgery should not be a last resort but instead should be used earlier, because prevention is definitely better than cure,” it concludes.

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