Effect of Bariatric Surgery Versus Intensive Medical Management on Diabetic Ophthalmic Outcomes

Glycemic control improves immediately after gastric bypass in patients with type 2 diabetes mellitus (T2DM) (1). The American Diabetes Association defines complete remission of diabetes as a return to normal glucose levels (HbA1c < 6%, fasting glucose <5.6 mmol/L) without glucose-lowering medication for at least 1 year after bariatric surgery (2). Prior studies have indicated that a rapid improvement in glycemic control is known to worsen diabetic retinopathy in cases of intense insulin control (3). However, few studies have examined whether undergoing bariatric surgery would significantly alter the prognosis of diabetes microvascular complications in patients with T2DM. The Surgical Therapy and Medications Potentially Eradicate Diabetes Efficiently (STAMPEDE) trial observed the effect of bariatric surgery versus intensive medical management on patients with diabetes and examined the ophthalmic outcomes at 2 years (4). This was a prospective, randomized, nonblinded clinical trial that enrolled 150 patients with the primary outcome of examining the efficacy of intensive medical therapy alone versus surgical management with either Roux-en-Y gastric bypass or sleeve gastrectomy for the management of T2DM. As a secondary end point of the trial, patients were assessed with biomicroscopic fundus exam by …