Bariatric surgery may arrest worsening of Diabetic foot complications among patients with type 2 diabetes: Study

Bariatric surgery is being increasingly recognized as a powerful intervention for severe obesity, leading to marked weight loss and improved blood sugar levels in patients with T2D. Given its prevalence and severity, there is increasing interest in how bariatric surgery might affect the incidence and progression of DFC in diabetic patients. The aim of this study was to estimate the impact of BS on the development of DFC and to establish the improvements in patients who had pre-existing symptoms of DFC after undergoing the surgery.

The changes in DFC in the context of bariatric surgery were systematically reviewed, from the databases like MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. The main outcome of interest was the incidence/worsening of DFC following bariatric surgery, while the secondary outcome was improvement in symptoms among those with pre-surgery DFC. The review included nine studies assessing the incidence of DFC after bariatric surgery, and six studies investigated changes in symptoms of DFC following surgery. Data were from RCTs and observational studies. Incidence rate metrics were IR, with respective CIs.

The main results of the present study showed conflicting results according to the following study design:

Randomized Controlled Trials:

• It stated that bariatric surgery did not result in a significantly reduced risk of developing or worsening DFC when weighed against conventional medical treatment. The incidence rate was 0.87, 95% CI being 0.26 to 2.98, hence insignificantly reducing the risk from bariatric surgery in RCTs.

Observational Studies:

• Observational data provided a better outcome: bariatric surgery was associated with a 51% lower risk of DFC development or worsening compared to no surgical treatments. The incidence rate was 0.49 (95% CI: 0.31, 0.77).

Improvement in Diabetic Neuropathy:

Bariatric surgery has been associated with improvement in various diabetic neuropathy-related assessments, such as:

• Toe tuning fork score

• Self-report neuropathy symptoms

• Neuropathy symptom score

• Neuropathy symptom profile

These findings suggest that the neuroprotective effects seen in diabetic neuropathy, a major risk factor in the development of foot complications in diabetes patients, may also be observed as improvements after bariatric surgery.

Bariatric surgery could, therefore, represent a potentially rewarding strategy in the reduction of risk of new-onset and worsening diabetes-related complications of the foot, as observed in various observational studies. It was also associated with an improvement in symptoms of diabetic neuropathy, which also plays an important role in developing foot complications. Not all these benefits have, however, been confirmed in randomized trials, but bariatric surgery provides a route of effective treatment among high-risk patients for DFC with T2D.

Reference:

Wang, Zhaonan, et al. “The Effect of Bariatric Surgery on Diabetes Related Foot Complications among Patients with Type 2 Diabetes: A Systematic Review.” Journal of Diabetes and Its Complications, vol. 38, no. 9, 1 Sept. 2024, pp. 108813–108813, https://doi.org/10.1016/j.jdiacomp.2024.108813.