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Association of Gastric Bypass Surgery With Risk of Developing Diabetic Retinopathy Among Patients With Obesity and Type 2 Diabetes in SwedenAn Observational Study

Educational Objective To investigate the incidence of diabetic ocular complications in patients with type 2 diabetes after gastric bypass surgery compared with the incidence of diabetic ocular complications in a matched cohort of patients with obesity and diabetes who have not undergone gastric bypass surgery.
1 Credit CME
Key Points

Question  What is the association of gastric bypass surgery with the risk of developing diabetic retinopathy (DR) among patients in Sweden with type 2 diabetes compared with a matched cohort of patients with obesity and type 2 diabetes who did not undergo gastric bypass surgery?

Findings  This cohort study of 5321 patients who had undergone gastric bypass surgery and 5321 matched controls found that gastric bypass surgery was associated with a decreased risk of developing DR, and there was no evidence of increased risk for development of sight-threatening DR.

Meaning  The results support previous studies showing a decreased risk of developing DR after gastric bypass surgery and suggest that the DR that develops is not sight-threatening DR.

Abstract

Importance  Knowledge of the incidence and progression of diabetic retinopathy (DR) after gastric bypass surgery (GBP) in patients with obesity and diabetes could guide the management of these patients.

Objective  To investigate the incidence of diabetic ocular complications in patients with type 2 diabetes after GBP compared with the incidence of diabetic ocular complications in a matched cohort of patients with obesity and diabetes who have not undergone GBP.

Design, Setting, and Participants  Data from 2 nationwide registers in Sweden, the Scandinavian Obesity Surgery Registry and the National Diabetes Register, were used for this cohort study. A total of 5321 patients with diabetes from the Scandinavian Obesity Surgery Registry who had undergone GBP from January 1, 2007, to December 31, 2013, were matched with 5321 patients with diabetes from the National Diabetes Register who had not undergone GBP, based on sex, age, body mass index (BMI), and calendar time (2007-2013). Follow-up data were obtained until December 31, 2015. Statistical analysis was performed from October 5, 2018, to September 30, 2019.

Exposure  Gastric bypass surgery.

Main Outcomes and Measures  Incidence of new DR and other diabetic ocular complications.

Results  The study population consisted of 5321 patients who had undergone GBP (3223 women [60.6%]; mean [SD] age, 49.0 [9.5] years) and 5321 matched controls (3395 women [63.8%]; mean [SD] age, 47.1 [11.5] years). Mean (SD) follow-up was 4.5 (1.6) years. The mean (SD) BMI and hemoglobin A1c concentration at baseline were 42.0 (5.7) and 7.6% (1.5%), respectively, in the GBP group and 40.9 (7.3) and 7.5% (1.5%), respectively, in the control group. The mean (SD) duration of diabetes was 6.8 (6.3) years in the GBP group and 6.4 (6.4) years in the control group. The risk for new DR was reduced in the patients who underwent GBP (hazard ratio, 0.62 [95% CI, 0.49-0.78]; P < .001). The dominant risk factors for development of DR at baseline were diabetes duration, hemoglobin A1c concentration, use of insulin, glomerular filtration rate, and BMI.

Conclusions and Relevance  This nationwide matched cohort study suggests that there is a reduced risk of developing new DR associated with GBP, and no evidence of an increased risk of developing DR that threatened sight or required treatment.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: November 3, 2020.

Published Online: January 14, 2021. doi:10.1001/jamaophthalmol.2020.5892

Corresponding Author: Hanna Åkerblom, PhD, Department of Ophthalmology, Region Västmanland, Västerås 72189, Sweden (hanna.akerblom@regionvastmanland.se).

Author Contributions: Drs Franzén and Svensson had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Franzén, Morén, Ottosson, Sundbom, Svensson, Granstam.

Acquisition, analysis, or interpretation of data: Åkerblom, Franzén, Zhou, Ottosson, Sundbom, Eliasson, Granstam.

Drafting of the manuscript: Åkerblom, Granstam.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Franzén, Zhou.

Obtained funding: Svensson.

Administrative, technical, or material support: Åkerblom, Zhou, Svensson.

Supervision: Ottosson, Sundbom, Eliasson, Granstam.

Conflict of Interest Disclosures: Dr Åkerblom reported serving as a member of the advisory board for Novartis, unrelated to the submitted work. Dr Eliasson reported receiving personal fees from AMGEN, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Mundipharma, Navamedic, NovoNordisk, and RLS Global; and grants and personal fees from Sanofi, outside the submitted work. Dr Granstam reported serving as a member of advisory boards for Novartis, Bayer, and Allergan, unrelated to the submitted work. No other disclosures were reported.

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