Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Feb;31(2):554-563.
doi: 10.1007/s11695-020-05052-8. Epub 2020 Oct 26.

Improvements in Diabetic Neuropathy and Nephropathy After Bariatric Surgery: a Prospective Cohort Study

Safwaan Adam  1   2 , Shazli Azmi  1   3 , Jan H Ho  1   3 , Yifen Liu  1 , Maryam Ferdousi  1   3 , Tarza Siahmansur  1 , Alise Kalteniece  1 , Andrew Marshall  1   3 , Shaishav S Dhage  1   2 , Zohaib Iqbal  1   3 , Yvonne D'Souza  3 , Salim Natha  4 , Philip A Kalra  1   5 , Rachelle Donn  1 , Basil J Ammori  1   5 , Akheel A Syed  1   5 , Paul N Durrington  1 , Rayaz A Malik  1   6 , Handrean Soran  7   8
Affiliations
Observational Study

Improvements in Diabetic Neuropathy and Nephropathy After Bariatric Surgery: a Prospective Cohort Study

Safwaan Adam et al. Obes Surg. 2021 Feb.

Abstract

Purpose: There are limited data on the impact of bariatric surgery on microvascular complications of type 2 diabetes (T2D), particularly diabetic neuropathy. We assessed microvascular complications (especially neuropathy) in obese patients with T2D before and 12 months after bariatric surgery.

Materials and methods: This was a prospective observational cohort study. Measurements of neuropathy symptom profile (NSP), neuropathy disability score (NDS), vibration (VPT), cold (CPT) and warm (WPT) perception thresholds, nerve conduction studies (NCS) and corneal confocal microscopy (CCM) to quantify corneal nerve fibre density (CNFD), branch density (CNBD) and fibre length (CNFL); urinary albumin/creatinine ratio (uACR), estimated glomerular filtration rate (eGFRcyst-creat) and retinal grading were taken.

Results: Twenty-six (62% female; median age 52 years) obese patients with T2D were recruited. Body mass index (BMI) (47.2 to 34.5 kg/m2; p < 0.001) decreased post-operatively. There were improvements in CNFD (27.1 to 29.2/mm2; p = 0.005), CNBD (63.4 to 77.8/mm2; p = 0.008), CNFL (20.0 to 20.2/mm2; p = 0.001), NSP (3 to 0/38; p < 0.001) and eGFRcyst-creat (128 to 120 ml/min; p = 0.015) post-bariatric surgery. Changes in (Δ) triglycerides were independently associated with ΔCNFL (β = - 0.53; p = 0.024) and Δsystolic blood pressure (β = 0.62;p = 0.017), and %excess BMI loss (β = - 0.004; p = 0.018) were associated with ΔeGFRcyst-creat. There was no significant change in NDS, VPT, CPT, WPT, NCS, uACR or retinopathy status. Glomerular hyperfiltration resolved in 42% of the 12 patients with this condition pre-operatively.

Conclusion: Bariatric surgery results in improvements in small nerve fibres and glomerular hyperfiltration in obese people with T2D, which were associated with weight loss, triglycerides and systolic blood pressure, but with no change in retinopathy or uACR at 12 months.

Keywords: Bariatric surgery; Microvascular; Nephropathy; Neuropathy; Obesity; Retinopathy; Small nerve fibre; Type 2 diabetes.

PubMed Disclaimer

Conflict of interest statement

Handrean Soran has received grants and personal fees from Akcea, grants and personal fees from Amgen, grants from Pfizer, grants and personal fees from MSD, personal fees from Sanofi, personal fees from Synageva and personal fees from Takeda, which are all outside of the submitted work. Rayaz A. Malik has received grants and personal fees from Pfizer and personal fees from Novo Nordisk, outside of the submitted work. None of the other authors have any relevant conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Microvascular outcome parameters before and after bariatric surgery. Figure 1 depicts significant improvements in the CNFD, CNBD and CNFL from baseline to 12 months after bariatric surgery. There were also significant reductions in the eGFR, serum creatinine and a change in uACR (non-significant). a Corneal confocal microscopy. a (i) Corneal nerve fibre density before and after surgery, (ii) corneal nerve branch density before and after surgery, (iii) corneal nerve fibre length before and after surgery. b Renal parameters. b (i) urinary albumin/creatinine ratio before and after surgery, (ii) estimated glomerular filtration rate before and after surgery, (iii) serum creatinine before and after surgery. CNFD, corneal nerve fibre density; CNBD, corneal nerve branch density; CNFL, corneal nerve fibre length; uACR, urinary albumin/creatinine ration; eGFR, estimated glomerular filtration rate; sCreat, serum creatinine
Fig. 2
Fig. 2
Example corneal confocal microscopy image in a participant. This image obtained using corneal confocal microscopy shows an improvement in the corneal nerve morphology from pre- (a) to post- (b) bariatric surgery. In the post-operative image (b), there are more nerves seen, and the red arrows depict small nerve fibre branches indicative of regeneration. The green arrows illustrate a main nerve fibre and the yellow arrows depict nerve fibre branches
See this image and copyright information in PMC

Comment in

References

    1. Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, Gutierrez JM, Frogley SJ, Ibele AR, Brinton EA, Hopkins PN, McKinlay R, Simper SC, Hunt SC. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377(12):1143–1155. doi: 10.1056/NEJMoa1700459. - DOI - PMC - PubMed
    1. Coleman KJ, Haneuse S, Johnson E, Bogart A, Fisher D, O’Connor PJ, Sherwood NE, Sidney S, Theis MK, Anau J, Schroeder EB, O’Brien R, Arterburn D. Long-term microvascular disease outcomes in patients with type 2 diabetes after bariatric surgery: evidence for the legacy effect of surgery. Diabetes Care. 2016;39(8):1400–1407. doi: 10.2337/dc16-0194. - DOI - PMC - PubMed
    1. Johnson BL, Blackhurst DW, Latham BB, Cull DL, Bour ES, Oliver TL, Williams B, Taylor SM, Scott JD. Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. J Am Coll Surg. 2013;216(4):545–556. doi: 10.1016/j.jamcollsurg.2012.12.019. - DOI - PubMed
    1. Sheng B, Truong K, Spitler H, Zhang L, Tong X, Chen L. The long-term effects of bariatric surgery on type 2 diabetes remission, microvascular and macrovascular complications, and mortality: a systematic review and meta-analysis. Obes Surg. 2017;27(10):2724–2732. doi: 10.1007/s11695-017-2866-4. - DOI - PubMed
    1. Merlotti C, Ceriani V, Morabito A, Pontiroli AE. Bariatric surgery and diabetic retinopathy: a systematic review and meta-analysis of controlled clinical studies. Obes Rev. 2017;18(3):309–316. doi: 10.1111/obr.12490. - DOI - PubMed

Publication types