Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
Centre for Diabetes, Endocrinology and Metabolism, Manchester University NHS Foundation Trust, Manchester, UK.
Obes Rev. 2023 Oct;24(10):e13602. doi: 10.1111/obr.13602. Epub 2023 Jul 29.
Bariatric surgery in people with obesity can lead to long-term remission of type 2 diabetes mellitus (T2DM) and a reduction in the incidence of macrovascular complications. The impact of bariatric surgery on microvascular complications is less clear. In this narrative review, we sought to evaluate the effect of bariatric surgery on microvascular complications in patients with and without diabetes. The risk of developing microvascular complications is increased in people with obesity, and this is amplified in those with T2DM. The impact of metabolic surgery on microvascular complications is limited to a subgroup analysis of studies or statistical modeling to predict the glycemia-independent effect of bariatric surgery. While bariatric surgery halts the progression of retinopathy in those with minimal retinopathy, it may worsen in those with advanced retinopathy. Bariatric surgery improves proteinuria and major renal outcomes, regardless of the severity of renal impairment. Bariatric surgery in patients with obesity with or without diabetes is associated with an improvement in neuropathic symptoms and regeneration of small nerve fibers. In conclusion, bariatric surgery is associated with an improvement in microvascular complications. Further studies are needed to elucidate the underlying mechanisms for the favorable effect of bariatric surgery on microvascular outcomes.
肥胖人群的减重手术可导致 2 型糖尿病（T2DM）的长期缓解，并降低大血管并发症的发生率。减重手术对微血管并发症的影响尚不明确。在本次叙述性综述中，我们旨在评估减重手术对糖尿病患者和非糖尿病患者微血管并发症的影响。肥胖人群发生微血管并发症的风险增加，而 T2DM 患者的风险则进一步增加。代谢手术对微血管并发症的影响仅限于研究的亚组分析或统计学模型，以预测减重手术对血糖无影响的效果。虽然减重手术可阻止轻度视网膜病变患者的视网膜病变进展，但它可能会使晚期视网膜病变患者的病情恶化。无论肾功能损伤的严重程度如何，减重手术均可改善蛋白尿和主要肾脏结局。减重手术可改善肥胖患者和合并糖尿病患者的神经病变症状和小神经纤维再生。总之，减重手术与微血管并发症的改善有关。需要进一步的研究来阐明减重手术对微血管结局有利影响的潜在机制。
