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Roux-en-Y Gastric Bypass Could Slow Progression of Retinopathy in Type 2 Diabetes: A Pilot Study

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Abstract

Background

Type 2 diabetes mellitus (T2DM) is a well-recognised complication of obesity. One of the microvascular complications of T2DM is diabetic retinopathy (DR). Bariatric surgery has been shown to effectively treat obesity and can induce remission of T2DM. It is not known what effect this improvement may have on pre-existing DR. We aimed to investigate this.

Method

A dual-centre, observer-blinded, case-control study investigated the progression of DR in patients who received Roux-en-Y gastric bypass (treatment group (TG)), compared with controls who received medical therapy (control group (CG)) for their T2DM. Retinal images were taken pre-operatively and approximately 2 years post-operatively for the TG and over a 2-year interval for the CG. Data were collected for confounding variables, including glycaemic control (HbA1c) and BMI.

Results

Forty-five patients were recruited (TG = 21, CG = 24). Groups were significantly heterogeneous. DR showed significant progression for those in the CG (p = 0.03) but not in TG (p = 0.135), no significant difference was found when adjusting for confounding variables (p = 0.480). There was a significant trend in favour of surgery in improvement of glycaemic control (p = 0.017).

Conclusion

The trends within these pilot data may represent a real difference in the progression of DR in patients who have received surgery, compared with medical treatment alone. Due to heterogeneity of group characteristics, further work needs to be done to validate these results. Should there be a true difference, there will be potential cost savings for the National Health Service (NHS) along with a reduced burden of disease for patients.

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Acknowledgments

This pilot study was submitted for a Master of Science Degree, awarded by the University of Edinburgh and the Royal College of Surgeons of Edinburgh. The corresponding author would like to acknowledge Mr. J Featonby, Miss H Cook and Dr. C Walton for assisting with Diabetic Retinopathy Screening Databases and thus recruitment of cases and controls, Mrs. D Phillips for assistance with ethics and NHS site permissions and Mr. J A Higginson for proof reading, general advice and assistance with statistics.

Conflict of Interest

All authors declare no conflict of interest.

Statement of Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Author notes

  1. Jenny Banks

    Present address: Department of Surgery, Torbay Hospital, Newton Road, Torquay, Devon, TQ2 7AA, UK

  2. Simon T. Adams, Kirstie Laughlan, Glenn V. Miller & Stephen H. Leveson

    Present address: Department of Surgery, The York Hospital, Wigginton Road, York, North Yorkshire, YO31 8HE, UK

  3. Victoria Allgar

    Present address: Hull York Medical School, University of York, John Hughlings Jackson Building, University of York, Heslington, York, North Yorkshire, YO10 5DD, UK

  4. Vijay Jayagopal

    Present address: Department of Diabetes and Endocrinology, The York Hospital, Wigginton Road, York, North Yorkshire, YO31 8HE, UK

  5. Richard Gale

    Present address: Department of Ophthalmology, The York Hospital, Wigginton Road, York, North Yorkshire, YO31 8HE, UK

  6. Peter Sedman

    Present address: Department of Surgery, Castle Hill Hospital, Castle Road, Cottingham, East Yorkshire, HU16 5JQ, UK

Authors and Affiliations

    Authors
    1. Jenny Banks
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    2. Simon T. Adams
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    3. Kirstie Laughlan
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    4. Victoria Allgar
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    8. Peter Sedman
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    9. Stephen H. Leveson
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    Corresponding author

    Correspondence to Jenny Banks.

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    Banks, J., Adams, S.T., Laughlan, K. et al. Roux-en-Y Gastric Bypass Could Slow Progression of Retinopathy in Type 2 Diabetes: A Pilot Study. OBES SURG 25, 777–781 (2015). https://doi.org/10.1007/s11695-014-1476-7

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