Compared with usual care, bariatric surgery was associated with half the incidence of microvascular disease at 5 years for adults with type 2 diabetes. These findings add to a growing body of evidence suggesting that bariatric surgery not only improves glucose, blood pressure, and lipid control, but is likely to reduce macrovascular and microvascular complications, as well as improve survival in patients with severe obesity and type 2 diabetes. Results from a matched cohort study are published in Annals of Internal Medicine.
Research has shown that about half of people with diabetes and severe obesity who get bariatric surgery maintain long-term glucose control without medication. But for many patients, avoiding microvascular complications affecting the nerves of the feet and hands (neuropathy), the kidneys (nephropathy), and the eyes (retinopathy) is of greater concern.
Researchers from Kaiser Permanente Washington Health Research Institute studied more than 4,000 obese patients with type 2 diabetes who underwent bariatric surgery to determine its effect on microvascular complications. They found that the risk of all microvascular complications at 5 years after surgery was less than half that of a matched control group of more than 11,000 obese patients who received usual medical care for their diabetes that did not include surgery. Overall, bariatric surgery was associated with a two-thirds decrease in neuropathy, one-half decrease in nephropathy, and one-third decrease in retinopathy.
According to the researchers, these results suggest that everyone with diabetes and severe obesity should have a conversation with their doctor about whether bariatric surgery is a reasonable treatment option for them, weighing the risks and benefits.
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Annals of Internal Medicine (2018). http://annals.org/aim/article/doi/10.7326/M17-2383