Department of Ophthalmology, Region Västmanland, Västerås, Sweden.
National Diabetes Register, Center of Registers, Gothenburg, Sweden.
JAMA Ophthalmol. 2021 Feb 1;139(2):200-205. doi: 10.1001/jamaophthalmol.2020.5892.
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.
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.
Gastric bypass surgery.
Incidence of new DR and other diabetic ocular complications.
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.
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.
了解肥胖合并糖尿病患者胃旁路手术后（GBP）糖尿病性视网膜病变（DR）的发生和进展情况，有助于指导此类患者的管理。
研究与未接受 GBP 的肥胖合并糖尿病的匹配队列相比，GBP 后 2 型糖尿病患者发生糖尿病眼部并发症的情况。
设计、地点和参与者：本队列研究使用了瑞典两个全国性注册中心的数据，即斯堪的纳维亚肥胖手术登记处和全国糖尿病登记处。2007 年 1 月 1 日至 2013 年 12 月 31 日，从斯堪的纳维亚肥胖手术登记处共纳入 5321 例接受 GBP 的糖尿病患者，根据性别、年龄、体重指数（BMI）和时间（2007-2013 年），与全国糖尿病登记处的 5321 例未接受 GBP 的糖尿病患者相匹配。随访数据截至 2015 年 12 月 31 日。统计分析于 2018 年 10 月 5 日至 2019 年 9 月 30 日进行。
胃旁路手术。
新发 DR 和其他糖尿病眼部并发症的发生率。
研究人群包括 5321 例接受 GBP（3223 例女性[60.6%]；平均[标准差]年龄 49.0[9.5]岁）和 5321 例匹配对照（3395 例女性[63.8%]；平均[标准差]年龄 47.1[11.5]岁）。平均（标准差）随访时间为 4.5（1.6）年。GBP 组的平均（标准差）基线 BMI 和糖化血红蛋白浓度分别为 42.0（5.7）和 7.6%（1.5），对照组分别为 40.9（7.3）和 7.5%（1.5）。GBP 组的平均（标准差）糖尿病病程为 6.8（6.3）年，对照组为 6.4（6.4）年。GBP 组新发 DR 的风险降低（风险比，0.62[95%CI，0.49-0.78]；P < 0.001）。基线时发生 DR 的主要危险因素为糖尿病病程、糖化血红蛋白浓度、胰岛素使用、肾小球滤过率和 BMI。
这项全国性匹配队列研究表明，GBP 与新发 DR 风险降低相关，且没有证据表明 DR 风险增加而威胁视力或需要治疗。
