The Effect of Bariatric Surgery on Diabetic Retinopathy: Good, Bad, or Both?

Bariatric surgery, initially intended as a weight-loss procedure, is superior to standard lifestyle intervention and pharmacological therapy for type 2 diabetes in obese individuals. Intensive medical management of hyperglycemia is associated with improved microvascular outcomes. Whether or not the reduction in hyperglycemia observed after bariatric surgery translates to improved microvascular outcomes is yet to be determined. There is substantial heterogeneity in the data relating to the impact of bariatric surgery on diabetic retinopathy (DR), the most common microvascular complication of diabetes. This review aims to collate the recent data on retinal outcomes after bariatric surgery. This comprehensive evaluation revealed that the majority of DR cases remain stable after surgery. However, risk of progression of pre-existing DR and the development of new DR is not eliminated by surgery. Instances of regression of DR are also noted. Potential risk factors for deterioration include severity of DR at the time of surgery and the magnitude of glycated hemoglobin reduction. Concerns also exist over the detrimental effects of postprandial hypoglycemia after surgery. In vivo studies evaluating the chronology of DR development and the impact of bariatric surgery could provide clarity on the situation. For now, however, the effect of bariatric surgery on DR remains inconclusive.

• Publication year

  2016

• Venue

  Diabetes & Metabolism Journal

• Publication date

  2016-09-27

• Fields of study

  Medicine

• Identifiers
  DOI 10.4093/dmj.2016.40.5.354PMID 27766242PMCID 5069391
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Monitoring of Diabetic Retinopathy in relation to Bariatric Surgery: a Prospective Observational Study

  2016influential reference
• The impact of bariatric surgery on retinopathy in patients with type 2 diabetes: a retrospective cohort study.

  2016influential reference
• Effects of gastric banding on glucose tolerance, cardiovascular and renal function, and diabetic complications: a 13-year study of the morbidly obese.

  2016cited by this paper
• Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes.

  2016cited by this paper
• Effect of Bariatric Surgery Versus Intensive Medical Management on Diabetic Ophthalmic Outcomes

  2015cited by this paper
• CLINICAL COURSE OF DIABETIC RETINOPATHY IN KOREAN TYPE 2 DIABETES AFTER BARIATRIC SURGERY: A Pilot Study

  2015cited by this paper
• Bariatric and metabolic surgery and microvascular complications of type 2 diabetes mellitus.

  2015cited by this paper
• Bariatric-metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial.

  2015cited by this paper
• Type 2 diabetes mellitus and microvascular complications 1 year after Roux-en-Y gastric bypass: a case–control study

  2015influential reference
• The Impact of Bariatric Surgery on Diabetic Retinopathy: A Systematic Review and Meta-Analysis

  2015cited by this paper
• Roux-en-Y Gastric Bypass Could Slow Progression of Retinopathy in Type 2 Diabetes: A Pilot Study

  2015influential reference
• Weight Loss Interventions and Progression of Diabetic Kidney Disease

  2015cited by this paper
• Progression of diabetic retinopathy after bariatric surgery

  2015cited by this paper
• Surgical vs medical treatments for type 2 diabetes mellitus: a randomized clinical trial.

  2014cited by this paper
• Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes.

  2014cited by this paper
• Does bariatric surgery adversely impact on diabetic retinopathy in persons with morbid obesity and type 2 diabetes? A pilot study.

  2014influential reference
• Association of bariatric surgery with long-term remission of type 2 diabetes and with microvascular and macrovascular complications.

  2014cited by this paper
• Metabolic surgery: shifting the focus from glycaemia and weight to end-organ health.

  2014cited by this paper
• Bariatric Surgery and Microvascular Complications of Type 2 Diabetes Mellitus

  2014influential reference
• Uso de prebióticos y probióticos en las fórmulas lácteas infantile

  2013cited by this paper
• Diabetic retinopathy: pathogenesis, clinical grading, management and future developments

  2013cited by this paper
• Roux-en-Y gastric bypass vs intensive medical management for the control of type 2 diabetes, hypertension, and hyperlipidemia: the Diabetes Surgery Study randomized clinical trial.

  2013cited by this paper
• Mechanisms of diabetic complications.

  2013cited by this paper
• Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus.

  2013cited by this paper
• Advanced glycation end products and diabetic retinopathy.

  2013cited by this paper
• Diabetic retinopathy.

  2013cited by this paper
• Effect of laparoscopic Roux-en-Y gastric bypass surgery on type 2 diabetes mellitus with hypertension: a randomized controlled trial.

  2013cited by this paper
• Endothelial dysfunction - a major mediator of diabetic vascular disease.

  2013cited by this paper
• Long-term remission of type 2 diabetes in morbidly obese patients after sleeve gastrectomy.

  2013influential reference
• Diabetic retinopathy.

  2012cited by this paper
• Global Prevalence and Major Risk Factors of Diabetic Retinopathy

  2012cited by this paper
• Bariatric Surgery Does Not Exacerbate and May Be Beneficial for the Microvascular Complications of Type 2 Diabetes

  2012cited by this paper
• Bariatric Surgery and Diabetic Retinopathy: a Pilot Analysis

  2012influential reference
• Advanced glycation end products and diabetic retinopathy

  2012cited by this paper
• Improved Arteriole‐to‐Venule Ratio of Retinal Vessels Resulting From Bariatric Surgery

  2012cited by this paper
• Advanced glycation end products and diabetic retinopathy

  2011cited by this paper
• Neurodegeneration as an early event in diabetic retinopathy.

  2011cited by this paper
• GLP-1 agonist treatment: implications for diabetic retinopathy screening.

  2011cited by this paper
• Neurodegeneration: An early event of diabetic retinopathy.

  2010cited by this paper
• Effects of medical therapies on retinopathy progression in type 2 diabetes.

  2010cited by this paper
• Effects of blood pressure lowering and intensive glucose control on the incidence and progression of retinopathy in patients with type 2 diabetes mellitus: a randomised controlled trial

  2009cited by this paper
• Glucose control and vascular complications in veterans with type 2 diabetes.

  2009cited by this paper
• Microvascular and Macrovascular Complications of Diabetes

  2008cited by this paper
• Microvascular and macrovascular complications

  2007cited by this paper
• The pathobiology of diabetic complications: a unifying mechanism.

  2005cited by this paper
• Epiretinal pathology of diffuse diabetic macular edema associated with vitreomacular traction.

  2005cited by this paper
• Retinopathy in diabetes.

  2004cited by this paper
• Diabetic retinopathy and diabetic macular edema: pathophysiology, screening, and novel therapies.

  2003cited by this paper
• [Diabetic retinopathy].

  2001influential reference
• UKPDS 50: Risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis

  2001cited by this paper
• Hyperglycemia-induced mitochondrial superoxide overproduction activates the hexosamine pathway and induces plasminogen activator inhibitor-1 expression by increasing Sp1 glycosylation.

  2000cited by this paper
• Long-term results of the Kumamoto Study on optimal diabetes control in type 2 diabetic patients.

  2000cited by this paper
• Progression of retinopathy after improved metabolic control in type 2 diabetic patients. Relation to IGF-1 and hemostatic variables.

  1999cited by this paper
• Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group.

  1998cited by this paper
• Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)

  1998cited by this paper
• Early worsening of diabetic retinopathy in the Diabetes Control and Complications Trial.

  1998cited by this paper
• Upregulation of Blood-Brain Barrier GLUT1 Glucose Transporter Protein and mRNA in Experimental Chronic Hypoglycemia

  1995cited by this paper
• Association of blindness to intensification of glycemic control in insulin-dependent diabetes mellitus.

  1994cited by this paper
• Diabetic Glycemic Control and Retinal Blood Flow

  1990cited by this paper
• Diabetic retinopathy. A clinical overview.

  1988cited by this paper
• Changes in diabetic retinopathy during pregnancy. Correlations with regulation of hyperglycemia.

  1986cited by this paper
• Rapid tightening of blood glucose control leads to transient deterioration of retinopathy in insulin dependent diabetes mellitus: the Oslo study.

  1985cited by this paper
• Insulin-like growth factors. Studies in diabetics with and without retinopathy.

  1983cited by this paper
• Hyperglycemia impairs retinal oxygen autoregulation in normal and diabetic dogs.

  1983cited by this paper

• Mapping the landscape of diabetes research; an Emirati perspective of trends, challenges, and opportunities

  2025cites this paper
• GLP-1 Receptor Agonist Outcomes, Safety, and BMI Change in a National Cohort of Dialysis Patients.

  2025cites this paper
• The cholesterol‐HDL‐glucose (CHG) index and traditional adiposity markers in predicting diabetic retinopathy and nephropathy

  2025cites this paper
• Short-Term and Long-Term Effects of Bariatric Surgery on Diabetic Retinopathy: A Systematic Review

  2025cites this paper
• Impact of Bariatric Surgery on Treatment Burden and Progression of Diabetic Retinopathy

  2024influential citation
• Author Response To: Remission of diabetes mellitus after bariatric surgery: the putative link with worsening diabetic retinopathy and a need for ongoing post-operative follow up retinal screening

  2024cites this paper
• Current Treatment Options for Diabetic Retinal Disease

  2024cites this paper
• Role of Systemic Factors in Improving the Prognosis of Diabetic Retinal Disease and Predicting Response to Diabetic Retinopathy Treatment.

  2024cites this paper
• The Importance of Glycaemic Control Before Bariatric Surgery: Preventing Microvascular and Metabolic Complications

  2024cites this paper
• Rapid Reduction of HbA1c and Early Worsening of Diabetic Retinopathy: A Real-World Population-Based Study in Subjects With Type 2 Diabetes.

  2023cites this paper
• Response to Letter to the Editor Concerning: Adam S. et al. Improvements in Diabetic Neuropathy and Nephropathy After Bariatric Surgery: a Prospective Cohort Study

  2022cites this paper
• New Insights into Treating Early and Advanced Stage Diabetic Retinopathy

  2022cites this paper
• The Safety of Pharmacological and Surgical Treatment of Diabetes in Patients with Diabetic Retinopathy—A Review

  2021cites this paper
• Early microvascular complications in type 1 and type 2 diabetes: recent developments and updates

  2021cites this paper
• Safety of Semaglutide

  2021cites this paper
• Outcomes of Diabetic Retinopathy Post-Bariatric Surgery in Patients with Type 2 Diabetes Mellitus

  2021cites this paper
• Future perspectives in diabesity treatment: Semaglutide, a glucagon-like peptide 1 receptor agonist (Review)

  2021cites this paper
• Weight management and multi-morbidity

  2020cites this paper
• Gastric Bypass for Type 2 Diabetes Mellitus on BMI >35

  2020cites this paper
• Safety of injectable semaglutide for type 2 diabetes

  2020cites this paper
• Clinical potential of treatment with semaglutide in type 2 diabetes patients

  2019cites this paper
• Bariatric Surgery and Adolescent Type 2 Diabetes

  2019cites this paper
• Diabetic Retinopathy in the Context of Patients with Diabetes

  2019cites this paper
• Diabetes-Related Eye Disease 2019

  2019cites this paper
• Diabetische Retinopathie bei Patienten mit Diabetes mellitus

  2019cites this paper
• Aggravation précoce de la rétinopathie diabétique lors de l’optimisation du contrôle glycémique

  2018cites this paper
• Early worsening of diabetic retinopathy due to intensive glycaemic control

  2018cites this paper
• diabetic retinopathy with rapid improvement in systemic glucose control: a

  2018influential citation
• Worsening of diabetic retinopathy with rapid improvement in systemic glucose control: A review

  2018influential citation
• Glucagon-Like Peptide 1 Receptor Agonists and the Risk of Incident Diabetic Retinopathy

  2018cites this paper
• MANAGEMENT OF ENDOCRINE DISEASE: Which metabolic procedure? Comparing outcomes in sleeve gastrectomy and Roux-en Y gastric bypass.

  2018cites this paper
• Excess visceral adiposity is associated with diabetic retinopathy in a multiethnic Asian cohort with longstanding type 2 diabetes

  2018cites this paper
• Semaglutide, reduction in glycated haemoglobin and the risk of diabetic retinopathy

  2018cites this paper
• GLP-1R as a Target for the Treatment of Diabetic Retinopathy: Friend or Foe?

  2017influential citation
• Bariatric Surgery for Adolescents with Type 2 Diabetes: an Emerging Therapeutic Strategy

  2017cites this paper
• Semaglutide, reduction in HbA1c and the risk of diabetic retinopathy:

  2017cites this paper
• Early worsening of diabetic retinopathy after rapid improvement of blood glucose control in patients with diabetes.

  2017cites this paper
• The Long-Term Effects of Bariatric Surgery on Type 2 Diabetes Remission, Microvascular and Macrovascular Complications, and Mortality: a Systematic Review and Meta-Analysis

  2017cites this paper
• The role of bariatric surgery to treat diabetes: current challenges and perspectives

  2017cites this paper
• Edinburgh Research Explorer Role of Systemic Factors in Improving the Prognosis of Diabetic Retinal Disease and Predicting Response to Diabetic Retinopathy Treatment

  year unknowncites this paper