R Murphy1, Y Jiang2, M Booth3, R Babor4, A MacCormick4,5, H Hammodat3, G Beban6, R M Barnes7, A L Vincent7,8. 1. Department of Medicine, University of Auckland, Auckland, New Zealand. 2. Department of Statistics, University of Auckland, Auckland, New Zealand. 3. Department of Surgery, North Shore Hospital, Auckland, New Zealand. 4. Department of Surgery, Middlemore Hospital, Auckland, New Zealand. 5. Department of Surgery, University of Auckland, Auckland, New Zealand. 6. Department of Surgery, Auckland City Hospital, Auckland, New Zealand. 7. Eye Department, Auckland District Health Board, Auckland, New Zealand. 8. Department of Ophthalmology, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand.
Abstract
AIM: To assess the impact of bariatric surgery on the progression of diabetic retinopathy in patients with Type 2 diabetes. METHOD: We conducted a retrospective, observational study of patients with Type 2 diabetes who underwent bariatric surgery between 1 January 2001 and 31 December 2012 and had hospital-based retinal screening records. Data were collected from four surgical centres. Those who had pre-operative retinal screening and at least one post-operative retinal screen were eligible for analysis. A generalized linear mixed model was used to explore significant clinical predictors on the post-operative grade severity over time, controlling for important baseline characteristics. RESULTS: Three hundred and eighteen patients were eligible for analysis. Of these, 68.6% had no diabetic retinopathy pre-operatively compared with 18.9%, 8.5% and 4% with a diabetic retinopathy grade of minimal, mild or moderate and higher, respectively. First post-operative retinal screening results showed that after surgery 73% had no change in their diabetic retinopathy grade, 11% regressed and 16% progressed. The probability of having a diabetic retinopathy grade of moderate or higher over time post surgery was significantly associated with the magnitude of HbA1c reduction from pre-surgery HbA1c levels, a shorter post-operative retinal screening duration, more severe pre-operative retinal screening grade, male gender and non-Maori/Pacific ethnicity. CONCLUSIONS: A higher pre-operative diabetic retinopathy grade, and a large decrease in HbA1c post surgery warrant closer monitoring of diabetic retinopathy after bariatric surgery. Further prospective, randomized studies are required to investigate the gender and ethnic differences found.
AIM: To assess the impact of bariatric surgery on the progression of diabetic retinopathy in patients with Type 2 diabetes. METHOD: We conducted a retrospective, observational study of patients with Type 2 diabetes who underwent bariatric surgery between 1 January 2001 and 31 December 2012 and had hospital-based retinal screening records. Data were collected from four surgical centres. Those who had pre-operative retinal screening and at least one post-operative retinal screen were eligible for analysis. A generalized linear mixed model was used to explore significant clinical predictors on the post-operative grade severity over time, controlling for important baseline characteristics. RESULTS: Three hundred and eighteen patients were eligible for analysis. Of these, 68.6% had no diabetic retinopathy pre-operatively compared with 18.9%, 8.5% and 4% with a diabetic retinopathy grade of minimal, mild or moderate and higher, respectively. First post-operative retinal screening results showed that after surgery 73% had no change in their diabetic retinopathy grade, 11% regressed and 16% progressed. The probability of having a diabetic retinopathy grade of moderate or higher over time post surgery was significantly associated with the magnitude of HbA1c reduction from pre-surgery HbA1c levels, a shorter post-operative retinal screening duration, more severe pre-operative retinal screening grade, male gender and non-Maori/Pacific ethnicity. CONCLUSIONS: A higher pre-operative diabetic retinopathy grade, and a large decrease in HbA1c post surgery warrant closer monitoring of diabetic retinopathy after bariatric surgery. Further prospective, randomized studies are required to investigate the gender and ethnic differences found.
Authors: Karen J Coleman; Sebastien Haneuse; Eric Johnson; Andy Bogart; David Fisher; Patrick J O'Connor; Nancy E Sherwood; Steve Sidney; Mary Kay Theis; Jane Anau; Emily B Schroeder; Rebecca O'Brien; David Arterburn Journal: Diabetes Care Date: 2016-06-06 Impact factor: 19.112
Authors: Matthew C Riddle; William T Cefalu; Philip H Evans; Hertzel C Gerstein; Michael A Nauck; William K Oh; Amy E Rothberg; Carel W le Roux; Francesco Rubino; Philip Schauer; Roy Taylor; Douglas Twenefour Journal: Diabetologia Date: 2021-08-30 Impact factor: 10.122
Authors: Matthew C Riddle; William T Cefalu; Philip H Evans; Hertzel C Gerstein; Michael A Nauck; William K Oh; Amy E Rothberg; Carel W le Roux; Francesco Rubino; Philip Schauer; Roy Taylor; Douglas Twenefour Journal: J Clin Endocrinol Metab Date: 2022-01-01 Impact factor: 6.134