An analysis conducted by investigators from the Surgical Department of the University of Heidelberg in cooperation with the Study Center of the German Surgical Society reported that in obese patients with type 2 diabetes, researchers found that weight loss surgery helps prevent the development of microvascular complications—which affect small blood vessels—better than medical treatment. The study findings published in the British Journal of Surgery (BJS).

Microvascular complications of diabetes include diabetic nephropathy, neuropathy, and retinopathy, which affect the kidneys, nerves, and eyes, respectively. These diabetes-related complications are responsible for the high healthcare costs of type 2 diabetes and the leading causes of dialysis, amputations, and blindness in the Western world.

Current standard treatment for T2DM involves lifestyle modifications and medical treatment, although these have no influence on cardiovascular complications despite improved glycaemic control and weight loss. Strong evidence indicates that bariatric surgery is superior to medical treatment regarding weight loss, glycaemic control and remission of diabetes.

The aim of this systematic review and meta-analysis was to assess the effects of metabolic surgery in comparison with medical treatment on both the incidence of microvascular complications (nephropathy, retinopathy, neuropathy) and on the improvement of pre-existing microvascular complications.

The risk of developing microvascular diabetic complications was 4-fold reduced in patients with type 2 diabetes undergoing surgery compared with patients with current guideline-based medical therapy. The analysis also found that pre-existing diabetic nephropathy was strongly improved by surgery compared with medical treatment.

The likelihood of improvement or remission in patients with diabetesrelated kidney damage was 15-times higher after surgery compared with current medical therapy. Medical therapy for type 2 diabetes seems to have reached its limitations, even with the newly available drugs.

Metabolic surgery strongly reduces the risk for diabetes-associated complications and seems even to improve existing diabetic kidney damage in 1 out of 2 operated patients. Such strong and reliable effects, especially on very difficult-to-treat diabetic kidney damage, are not even remotely possible with the current medical therapy.

The study findings showed that in patients with T2DM, metabolic surgery prevented the development of microvascular complications better than medical treatment. Metabolic surgery improved pre-existing diabetic nephropathy compared with medical treatment.