The weight loss surgery may help reverse peripheral neuropathy and improve the stability of cardiovascular autonomic neuropathy and retinopathy in individuals with class II/III obesity.
Bariatric surgery may be an effective approach to manage 2 major diabetes complications in individuals with class II/III obesity: peripheral neuropathy (PN) and cardiovascular autonomic neuropathy (CAN).
A prospective cohort study published in Diabetologia found that bariatric surgery was effective at improving several metabolic risk factors, with the exception of blood pressure (BP) and total cholesterol. There was also a significant mean (SD) weight loss of 31.0 (18.4) kg observed at the 2-year follow-up after bariatric surgery, and fewer individuals were found to be taking antihypertensive medications after the surgery.
Two years following bariatric surgery, one of the primary PN outcomes, intraepidermal nerve fiber density (IENFD) in the proximal thigh, showed a mean improvement of 3.4 (7.8) fibers/mm (P < .01). The other primary outcome, IENFD in the distal leg, remained stable, only improving by 0.1 (4.1) fibers/mm (P = .92).
Meanwhile, the primary outcomes for CAN remained stable with a mean E/I ratio of −0.01 (0.1; P = .89). Retinopathy, measured by mean deviation using frequency doubling technology (FDT) also remained stable with a deviation of −0.2 (3.0; P = .52).
Multiple secondary CAN outcomes showed improvement, and linear regression revealed that a greater reduction in fasting glucose was associated with improvements in retinopathy.
“Our findings probably indicate an improvement compared with the natural history of worsening PN, CAN, and retinopathy over time,” the authors said, citing previous studies.
A total of 163 individuals participated in the study, of which 127 (77.9%) successfully completed all baseline visits and underwent bariatric surgery. Of these 127 participants, 79 (62.2%) completed 2-year follow-up visits in person, while an additional 22 participants completed partial virtual measures due to COVID-19, resulting in a follow-up completion rate of 79.5%.
After undergoing bariatric surgery, several participants experienced difficulties in tolerating glucose tolerance testing due to anatomical changes resulting from the surgery. As a result, data collection for these tests was discontinued after June 2018. Of the 79 participants who successfully completed in-person follow-up visits, 71 (89.9%) had undergone sleeve gastrectomy, and 8 (10.1%) had undergone gastric bypass surgery.
Among the 79 participants who completed in-person follow-up, the mean (SD) age was 46.0 (11.3) years. Most of these participants were female (73.4%), White (79.7%), and non-Hispanic (98.7%). The authors observed no significant demographic differences among participants who completed in-person follow-up, virtual follow-up, or were lost to follow-up.
The authors also observed that changes in fasting glucose levels were associated with improvements in retinopathy, but that no other metabolic changes were correlated with measures of diabetes complications. Additionally, bariatric surgery was shown to have positive effects on several patient-oriented outcomes, including patient-reported quality of life, pain, and depression.
“Our study demonstrates that bariatric surgery may be an effective approach to reverse PN in individuals with obesity, either through the direct impact of metabolic improvement or other beneficial effects of bariatric surgery,” the authors concluded. “Given the natural history of worsening CAN and retinopathy, stability in these complications probably indicates a successful result; however, randomised controlled trials are needed to confirm these findings. For retinopathy, a specific reduction in hyperglycaemia following bariatric surgery is probably required to reverse this complication.”
Reference
Reynolds EL, Watanabe M, Banerjee M, et al. The effect of surgical weight loss on diabetes complications in individuals with class II/III obesity. Diabetologia. 2023;1-16. doi:10.1007/s00125-023-05899-3
Public Hospitals More Likely to Extend Unprofitable Services After 340B Participation, Study Finds
May 10th 2024Public hospitals were significantly more likely to sustain access to unprofitable services following 340B Drug Pricing Program participation, while nonprofit hospitals were mostly unaffected, according to a recent study.
Read More
Frameworks for Advancing Health Equity: Urban Health Outreach
May 9th 2024In the series debut episode of "Frameworks for Advancing Health Equity," Mary Sligh, CRNP, and Chelsea Chappars, of Allegheny Health Network, explain how the Urban Health Outreach program aims to improve health equity for individuals experiencing homelessness.
Listen
Persistence Pays Off With Zanubrutinib: A Challenging CLL Case With a Prior BTK Inhibitor Failure
May 10th 2024The case of a 77-year-old woman with a long chronic lymphocytic leukemia (CLL) history illustrates the novel use of zanubrutinib as a potential option for some patients who have failed first-generation Bruton tyrosine kinase (BTK) inhibitors and venetoclax.
Read More
CMS Medicare Final Rule: Advancing Benefits, Competition, and Consumer Protection
May 7th 2024On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.
Listen