Clinical Outcomes of Metabolic Surgery: Microvascular and Macrovascular Complications

Abstract

Understanding of the long-term clinical outcomes associated with bariatric surgery has recently been advanced. Research related to the sequelae of diabetes-in particular, long-term microvascular and macrovascular complications-in patients who undergo weight-loss surgery is imperative to this pursuit. While numerous randomized control trials have assessed glucose control with bariatric surgery compared with intensive medical therapy, bariatric surgery outcome data relating to microvascular and macrovascular complications have been limited to observational studies and nonrandomized clinical trials. As a result, whether bariatric surgery is associated with a long-term reduction in microvascular and macrovascular complications when compared with current intensive glycemic control therapy cannot be determined because the evidence is insufficient. However, the consistent salutary effects of bariatric surgery on diabetes remission and glycemic improvement support the opportunity (and need) to conduct high-quality studies of bariatric surgery versus intensive glucose control. This review provides relevant background information related to the treatment of diabetes, hyperglycemia, and long-term complications; reports clinical findings (to date) with bariatric surgery; and identifies ongoing research focusing on long-term vascular outcomes associated with bariatric surgery.

Figure 1

Conceptual model for outcomes of surgical treatment for diabetes and severe obesity. “See this issue” refers to physiological mechanistic changes after bariatric surgery (as highlighted in this special issue) that may contribute to diabetes remission/relapse and eventual microvascular and macrovascular outcomes. *May be associated with average glycemia duration. †Amelioration of hypertension and dyslipidemia through weight loss can also affect complication risk.