Yi-Cheng Chang1,2,3, Seh-Huang Chao4, Ching-Chu Chen5,6, Kong-Han Ser7, Keong Chong8, Chieh-Hsiang Lu9, Meng-Lun Hsieh1,2, Yu-Yao Huang10, Yi-Chih Lee11, Chih-Cheng Hsu12, Lee-Ming Chuang13,14, Wei-Jei Lee15,16. 1. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. 2. Graduate Institute of Medical Genomics and Proteomics, National Taiwan University, Taipei, Taiwan. 3. Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan. 4. Division of General Surgery, Jen-Ai Hospital, Taichung, Taiwan. 5. Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan. 6. School of Chinese Medicine, China Medical University, Taichung, Taiwan. 7. Department of Surgery, Ten-Chen General Hospital, Taoyuan, Taiwan. 8. Department of Medicine, Min-Sheng General Hospital, Taoyuan, Taiwan. 9. Division of Metabolism & Endocrinology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan. 10. Division of Metabolism & Endocrinology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. 11. Department of International Business, Chien Hsin University of Science and Technology, Taoyuan, Taiwan. 12. Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan. 13. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. leeming@ntu.edu.tw. 14. Graduate Institute of Molecular Medicine, National Taiwan University, Taipei, Taiwan. leeming@ntu.edu.tw. 15. Division of General Surgery, Min-Sheng General Hospital, Taoyuan, Taiwan. wjlee_obessurg_tw@yahoo.com.tw. 16. Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan. wjlee_obessurg_tw@yahoo.com.tw.
Abstract
BACKGROUND: Bariatric surgery has been shown to improve glycemic control in patients with type 2 diabetes. However, less is known whether it can also reduce diabetic renal, neurological, and ophthalmic complications. METHODS: This prospective multicenter cohort study compared renal, ophthalmic, and neurological complications between 49 patients with obesity/overweight receiving bariatric surgery and 338 patients receiving standard medical treatment after follow-up for 2 years. Patients received neurological examinations including toe tuning fork vibration test, ankle tendon reflex test, 10-g monofilament test, and ophthalmic examinations including visual acuity measurement and fundus examinations. Multiple regressions, propensity score weighting, and matching were employed to adjust for baseline differences. RESULTS: After 2 years of follow-up, patients with type 2 diabetes receiving bariatric surgery had greater reduction in BMI, HbA1c, and urine albumin-creatinine ratio, greater improvement in estimated glomerular filtration rate, and greater increase in tuning fork test score of right and left toes compared with the medical group. However, there is no improvement in 10 g-monofilament test, visual acuity, diabetic non-proliferative retinopathy, and proliferative retinopathy. Similar results were obtained using multiple regression adjustment, propensity-score weighting, or comparing age-, sex-, and BMI-matched subjects. CONCLUSIONS: After 2-year follow-up, patients with obesity/overweight and type 2 diabetes receiving bariatric surgery have increased glomerular filtration rate, reduced albuminuria, and improved tuning folk vibration sensation.
BACKGROUND: Bariatric surgery has been shown to improve glycemic control in patients with type 2 diabetes. However, less is known whether it can also reduce diabetic renal, neurological, and ophthalmic complications. METHODS: This prospective multicenter cohort study compared renal, ophthalmic, and neurological complications between 49 patients with obesity/overweight receiving bariatric surgery and 338 patients receiving standard medical treatment after follow-up for 2 years. Patients received neurological examinations including toe tuning fork vibration test, ankle tendon reflex test, 10-g monofilament test, and ophthalmic examinations including visual acuity measurement and fundus examinations. Multiple regressions, propensity score weighting, and matching were employed to adjust for baseline differences. RESULTS: After 2 years of follow-up, patients with type 2 diabetes receiving bariatric surgery had greater reduction in BMI, HbA1c, and urine albumin-creatinine ratio, greater improvement in estimated glomerular filtration rate, and greater increase in tuning fork test score of right and left toes compared with the medical group. However, there is no improvement in 10 g-monofilament test, visual acuity, diabetic non-proliferative retinopathy, and proliferative retinopathy. Similar results were obtained using multiple regression adjustment, propensity-score weighting, or comparing age-, sex-, and BMI-matched subjects. CONCLUSIONS: After 2-year follow-up, patients with obesity/overweight and type 2 diabetes receiving bariatric surgery have increased glomerular filtration rate, reduced albuminuria, and improved tuning folk vibration sensation.