Abstract
Bariatric surgery is an emerging therapeutic approach for obese type 2 diabetes mellitus (T2DM) patients, with proven benefits for achieving target glucose control and even remission of diabetes. However, the effect of bariatric surgery upon diabetic retinopathy is still a subject of debate as some studies show a positive effect while others raise concerns about potential early worsening effects. We performed a systematic review, on PubMed, Science Direct, and Web of Science databases regarding the onset and progression of diabetic retinopathy in obese T2DM patients who underwent weight-loss surgical procedures. A total of 6375 T2DM patients were analyzed. Most cases remained stable after bariatric surgery (89.6%). New onset of diabetic retinopathy (DR) was documented in 290 out of 5972 patients (4.8%). In cases with DR at baseline, progression was documented in 50 out of 403 (12.4%) and regression in 90 (22.3%). Preoperative careful preparation of hemoglobin A1c (HbA1c), blood pressure, and lipidemia should be provided to minimize the expectation of DR worsening. Ophthalmologic follow-up should be continued regularly in the postoperative period even in the case of diabetic remission. Further randomized trials are needed to better understand the organ-specific risk factors for progression and provide personalized counseling for T2DM patients planned for bariatric surgery.
Highlights
Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder characterized by insulin resistance and progressive failure of beta-pancreatic cells
We evaluated the type of study, the number of patients enrolled, the percentage of patients with DR at baseline, type of bariatric surgery, the percentage of patients who experienced de novo onset of diabetic retinopathy, progression or regression of diabetic retinopathy, and changes in HbA1c, systolic blood pressure and lipid profile
The studies included in the qualitative analysis were published between 2012 and 2021, and the mean follow up ranged between 6 months and 5 years, with a median of 28.1 months
Summary
Type 2 diabetes mellitus (T2DM) is a complex metabolic disorder characterized by insulin resistance and progressive failure of beta-pancreatic cells. The global prevalence of T2DM is estimated to rise from 8.3% in 2011 to 9.9% in 2030 [1]. The increase in T2DM incidence is well correlated with the global burden represented by a high prevalence of obesity, especially in the younger ages. Recent studies documented the link between high body mass index (BMI) and diabetes via proinflammatory cytokines, insulin resistance, increased levels of circulating fatty acids, and impaired cellular metabolism [2]. The patients newly diagnosed with T2DM are advised to lose weight and perform physical exercise to improve glycemic control and to achieve a target HbA1c below 7%, as recommended by the American Diabetes Association [3,4,5]. Patients that lose weight by lifestyle changes, diet, or medication are not likely to maintain the results over time
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