Bariatric surgery in individuals with type 2 diabetes is not associated with short or long-term risk of diabetic retinopathy progression: results from a nationwide cohort study

Anne S. Thykjær*, Louise Rosengaard, Nis Andersen, Jens Andresen, Toke Bek, Javad Hajari, Steffen Heegaard, Kurt Højlund, Ryo Kawasaki, Caroline S. Laugesen, Sören Möller, Frederik N. Pedersen, Katja C. Schielke, Lonny Stokholm, Jakob Grauslund

*Corresponding author for this work

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Abstract

Aims
Bariatric surgery is used to induce weight loss and glycemic stability in type 2 diabetes (T2D). It has been a concern that this may lead to early worsening of diabetic retinopathy (DR) due to a rapid decline in HbA1c. In this study, we evaluated the risk of short and long-term DR development and need for ocular intervention in an entire nation of individuals with T2D undergoing bariatric surgery.

Methods
The study comprised a national, register-based cohort of individuals with T2D screened for DR. Cases were matched by age, sex and DR level at the date of surgery (index date) with non-bariatric controls. We extracted information on DR levels, in- and outpatient treatments, pharmaceutical prescriptions and laboratory values. We evaluated worsening of DR (incident and progressive DR) at follow-up (6 and 36 months).

Results
Amongst 238,967 individuals with T2D, who attended diabetic eye screening, we identified 553 that underwent bariatric surgery (0.2%) and 2677 non-bariatric controls. Median age was 49 years, and 63% were female. Cases had more comorbidities, lower HbA1c as well as more frequent use of glucose-lowering and antihypertensive medication than controls at index date. In a fully adjusted logistic regression model, the risk of DR worsening for cases was not significantly different compared to controls, neither short-term (OR 0.41 [CI 95% 0.13; 1.33], p = 0.14) nor long-term (OR 0.64 [CI 95% 0.33; 1.24], p = 0.18).

Conclusions
In this nationwide study, bariatric surgery did not associate with increased risk of short- or long-term DR worsening.
Original languageEnglish
JournalActa Diabetologica
Volume60
Issue number11
Pages (from-to)1531-1539
Number of pages9
ISSN0940-5429
DOIs
Publication statusPublished - Nov 2023

Bibliographical note

© 2023. The Author(s).

Keywords

  • Bariatric surgery
  • Diabetes
  • Diabetic retinopathy
  • Epidemiology
  • Nationwide

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