Impact of Bariatric Surgery on Microvascular Complications of Type 2 Diabetes

Takeaway

• Bariatric surgery was associated with improvement in measures of diabetic neuropathy and diabetic kidney disease but not diabetic retinopathy in obese patients with type 2 diabetes (T2D).
• These improvements were mainly driven by improvement in weight, systolic blood pressure (SBP) and triglycerides level.

Why this matters

• Bariatric surgery is an effective treatment for the remission of T2D and has long-term benefits for major macrovascular and microvascular events.
• However, there are limited studies assessing early outcomes in relation to microvascular complications, particularly neuropathy.

Study design

• This prospective observational cohort study assessed microvascular complications (especially neuropathy) in obese patients with T2D (n=26) before and 12 months after bariatric surgery.
• Funding: None disclosed.

Key results

• There was a significant reduction in body mass index (BMI) post-bariatric surgery (47.2 to 34.5 kg/m²; P<.001).
• There were significant improvements after surgery in:
  • corneal nerve fibre density (27.1 to 29.2/mm²; P=.005);
  • corneal nerve branch density (63.4 to 77.8/mm²; P=.008);
  • corneal nerve fibre length (CNFL; 20.0 to 20.2/mm²; P=.001);
  • neuropathy symptom profile (3 to 0/38; P<.001), and
  • estimated glomerular filtration rate cyst-creat (ΔeGFRcyst-creat; 128 to 120 mL/min; P=.015).
• Changes in (Δ) triglycerides independently correlated with ΔCNFL (β=−0.53; P=.024) and ΔSBP (β=0.62; P=.017) and % excess BMI loss (β=−0.004; P=.018) were linked with ΔeGFRcyst-creat.
• No significant changes were observed in the neuropathy disability score, vibration perception threshold, cold perception threshold, warm perception threshold, nerve conduction studies, urinary albumin/creatinine ratio and retinopathy status.
• Glomerular hyperfiltration resolved in 5 of the 12 patients with this condition pre-operatively.

Limitations

• Small sample size and lack of a matched control group.

This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.