Table 1Major studies comparing intensive medical management to conventional medical management of type 2 diabetes mellitus and the associated DR outcomes
Study |
No. |
Follow-up, yr |
New onset DR, % |
Progression of DR, % |
UKPDS [23] |
718 |
12 |
- |
Intensive: 38.6 Conventional: 48.7 (P=0.015) |
Kumamoto study [24] |
110 |
8 |
Intensive: 15.4 Conventional: 47.8 (P=0.022) |
Intensive: 24 Conventional: 56 (P=0.023) |
ADVANCE [25] |
1,241 |
4 |
Absolute incidence and progression Intensive: 14 Conventional: 16.2 (P=0.27) |
- |
ACCORD [26] |
2,856 |
4 |
- |
Intensive: 7.3 Conventional: 10.4 (P=0.003) |
VADT [37] |
1,791 |
5.6 |
Intensive: 42.2 Conventional: 48.9 (P=0.27) |
Intensive: 17 Conventional: 22.1 (P=0.07) |
Table 2Summary of studies reporting on the surgical management of type 2 diabetes mellitus and the associated DR outcomes
Study |
No. |
Follow-up |
New onset DR |
Progression of pre-existing DR |
Regression of pre-existing DR |
No change in DR status |
Varadhan et al. (2012) [42] |
22 |
6–12 mo |
2/15 (13%) |
2/7 (29%) |
2/7 (29%) |
16/22 (73%) |
Miras et al. (2012) [43] |
67 |
12–18 mo |
0/39 (0%) |
1/28 (3.6%) |
5/28 (17.8%) |
61/67 (91%) |
Thomas et al. (2014) [45] |
38 |
12 mo |
4/26 (15%) |
3/12 (25%) |
5/12 (42%) |
26/38 (68%) |
Amin et al. (2016) [46] |
S: 152 M: 155 |
3 yr |
29/106 (27%) |
5/41 (12%) |
5/41 (12%) |
113/152 (74%) |
Miras et al. (2015) [47] |
S: 56 M: 21 |
1 yr |
S and M: 0/77 (0%) |
S: 6/56 (11%) M: 3/21 (14%) |
S: 6/56 (11%) M: 1/21 (5%) |
S: 44/56 (78%) M: 17/21 (81%) |
Murphy et al. (2015) [48] |
0318 |
334 day |
38/218 (17%) |
12/100 (12%) |
35/100 (35%) |
232/318 (73%) |
Kim et al. (2015) [49] |
20 |
12 mo |
2/12 (16.6%) |
7/8 (87.5%) |
1/8 (12.5%) |
10/12 (83.3%) |
Banks et al. (2015) [50] |
S: 21 M: 24 |
2 yr |
Surgery: mean deterioration of 0.24 grades (P=0.135) Controls: mean deterioration of 0.38 grades (P=0.026) |
|
Zakaria et al. (2016) [53] |
S: 21 M: 24 |
13 yr |
Surgery: 0/20 (0%) Controls: 1/20 (5%) |
- |
- |
Surgery: 1/1 (100%) Controls: 4/4 (100%) |
Abbatini et al. (2013) [54] |
33 |
3 or 5 yr |
No new incidences of DR (32/32) |
- |
- |
NPDR: 1/1 (100%) |
Brynskov et al. (2016) [51] |
56 |
1, 3, 6, and 12 mo |
12 mo: 0/32 (0%) At 6 mo: 1/32 (3%) |
12 mo: 3/24 (13%)
5/24 (21%) at any follow-up visit |
12 mo: 4/24 (17%)
6/24 (25%) at any visit |
12 mo: 49/56 (87.5%) |
Singh et al. (2015) [52] |
150 |
2 yr |
No difference between bariatric surgery and intensive medical management |
86.5% of all participants (n=150) |
Johnson et al. (2013) [44] |
15,951 |
20 mo |
Surgery vs. Controls Diagnosis of blindness: <0.1% vs. 0.3% Laser eye/retinal surgery required: 0.2% vs. 0.6% |
|
Table 3Summary of DR status at baseline and the associated retinal outcomes after bariatric surgery
Preoperative DR status |
Deteriorated |
Stable |
Improved |
No retinopathy (n=443) |
|
|
|
Thomas et al. (2014) [45] |
4/26 |
22/26 |
Amin et al. (2016) [46] |
29/106 |
77/106 |
Murphy et al. (2015) [48] |
38/218 |
180/218 |
Kim et al. (2015) [49] |
2/12 |
10/12 |
Zakaria et al. (2016) [53] |
0/20 |
20/20 |
Abbatini et al. (2013) [54] |
0/32 |
32/32 |
Brynskov et al. (2016) [51] |
0/29 |
29/29 |
Total no. (%) |
73/443 (16.5) |
370/443 (83.5) |
Non-proliferative retinopathy (n=179) |
|
|
|
Thomas et al. (2014) [45] |
1/10 |
4/10 |
5/10 |
Amin et al. (2016) [46] |
5/42 |
32/42 |
5/42 |
Murphy et al. (2015) [48] |
12/99 |
52/99 |
35/99 |
Kim et al. (2015) [49] |
5/6 |
1/6 |
0/6 |
Zakaria et al. (2016) [53] |
0/1 |
1/1 |
0/1 |
Abbatini et al. (2013) [54] |
0/1 |
1/1 |
0/1 |
Brynskov et al. (2016) [51] |
2/20 |
15/20 |
3/20 |
Total no. (%) |
25/179 (14.0) |
106/179 (59.2) |
48/179 (26.8) |
Proliferative (n=12) |
|
|
|
Thomas et al. (2014) [45] |
2/2 |
0/2 |
0/2 |
Amin et al. (2016) [46] |
0/4 |
4/4 |
0/4 |
Murphy et al. (2015) [48] |
0/1 |
1/1 |
0/1 |
Kim et al. (2015) [49] |
2/2 |
0/2 |
0/2 |
Zakaria et al. (2016) [53] |
0/0 |
0/0 |
0/0 |
Abbatini et al. (2013) [54] |
0/0 |
0/0 |
0/0 |
Brynskov et al. (2016) [51] |
1/3 |
1/3 |
1/3 |
Total no. (%) |
5/12 (41.6) |
6/12 (50) |
1/12 (8.3) |