Background and Objectives: Diabetic retinopathy (DR) is a common diabetes complication and a leading cause of blindness. Although bariatric surgery (BS) is well studied for diabetes management, its effects on DR onset and progression, particularly long-term outcomes, remain underexplored. This review seeks to evaluate the short- and long-term retinal outcomes of BS in diabetic patients. Materials and Methods: A systematic search of PubMed, Web of Science, and Cochrane Library was conducted following PRISMA 2020 guidelines, including the use of the PRISMA checklist and flow diagram. The search included English-language articles (2014-2024) using keywords like "diabetic retinopathy" and "bariatric surgery". The review excluded studies published in languages other than English, as well as reviews, case reports, and those lacking adequate data or relevance. The risk of bias was determined by using the Downs and Black checklist. A systematic review of the literature was conducted, and the results were organized and displayed in tables to summarize and compare the main findings. Results: After screening 158 articles, 13 studies involving 17,903 patients were selected, focusing on the effects of BS on DR progression and regression. Short-term data suggest that BS may stabilize or improve DR but poses risks of worsening in advanced cases, requiring careful monitoring. However, long-term findings are inconsistent, with evidence of both DR regression and progression. These variations highlight the need for further research. Discussion: BS generally improves DR progression, but its effect depends on preoperative severity and glycemic control. Further studies should explore additional risk factors to better predict DR outcomes post-surgery. Conclusions: BS improves weight management, blood pressure, and diabetes control, potentially benefiting DR. However, the long-term effects remain uncertain due to conflicting findings. Rapid glycemic changes after surgery may pose risks of DR progression. Large-scale, longitudinal studies are needed to clarify the role of BS in DR progression and regression.

Bariatric interventions have shown the best therapeutic benefits in individuals with obesity. They can be classified into surgical procedures (bariatric/metabolic surgery) and endoscopic procedures. Common surgical procedures include sleeve gastrectomy, Roux-en-Y gastric bypass, bilio-pancreatic diversion with or without duodenal switch and Stomach Intestinal Pylorus Sparing Surgery. Endoscopic procedures include intragastric balloons, transpyloric shuttle, endoscopic gastroplasties, aspiration therapy, duodenal mucosal resurfacing, duodeno-jejunal bypass liner, gastro-duodeno-jejunal bypass and incisionless magnetic anastomosis system among others. However, these procedures are limited by lack of wide availability, high costs, immediate and long-term complications and poor acceptability in some regions. Weight re-gain is a common concern and revisional metabolic surgery is often required. Appropriate pre-operative evaluation and correction of nutritional deficiencies post-surgery are very important. The most appropriate procedure for a person would depend on multiple factors like the intended magnitude of weight-loss, comorbidities and surgical fitness, as well as choice of the patient. Recently, glucagon-like insulinotropic peptide-1 receptor agonists (GLP) and the GLP-1/gastric inhibitory polypeptide co-agonist-Tirzepatide have shown remarkable weight loss potential, which is at par with bariatric interventions in some patients. How far these can help in avoiding invasive bariatric procedures in near future remains to be explored. An updated and comprehensive clinical review by He et al in the recent issue of World Journal of Diabetes address has addressed the avenues and challenges of currently available bariatric surgeries which will enable clinicians to make better decisions in their practice, including their applicability in special populations like the elderly and pediatric age groups, type 1 diabetes mellitus, and non-diabetics.

Bariatric surgery has been shown to significantly affect type 2 diabetes mellitus (T2DM) remission, particularly in obese individuals. This systematic review aims to evaluate the effectiveness of bariatric surgical interventions in inducing remission of T2DM as well as to identify factors influencing surgical outcomes. The systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed across multiple databases, including PubMed, Embase, and Cochrane Library, utilizing text words and controlled vocabulary in various combinations with Boolean operators "AND" and "OR." The search was limited to open-access, full-text articles in English published from 2005 to 2024, including studies involving human subjects. The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist. In the study selection process for the systematic review, records were initially identified from three databases: Cochrane (31 records), Embase (62 records), and PubMed (52 records). This yielded 145 records. After removing 107 records, 38 records remained for screening. Of these, five records were excluded based on irrelevant problems and irrelevant outcomes. Subsequently, 33 reports were sought for full-text retrieval, with all reports being retrievable. The 33 reports were assessed for eligibility. Out of these, six were excluded due to an inaccessible full-text record. Finally, 33 studies met the inclusion criteria and were included in the review. Bariatric surgery is a highly effective intervention for individuals with T2DM, particularly those with obesity. It leads to significant weight loss and improved glycemic control through mechanisms that reduce stomach size and alter hormonal responses. This surgery not only helps many patients achieve remission from diabetes but also decreases the risk of obesity-related health issues. Beyond physical health, patients often report enhanced psychological well-being and quality of life. Overall, bariatric surgery can transform the health trajectory of select individuals, offering them a renewed sense of control and improved overall health.

In this editorial, we comment on the article by He et al, specifically in relation to the efficacy of bariatric surgery vs glucagon-like peptide-1 receptor agonist (GLP-1RA) therapy in the management of type 2 diabetes (T2D) associated with obesity. Bariatric surgery has now also been shown to be safe and effective in pre-teens and teenagers with obesity and T2D, but information on newer GLP-1RAs in these groups is predictably limited. In older individuals (age > 65 years), both bariatric surgery and GLP-1RA therapy improve cardiovascular outcomes. Bariatric surgery is not infrequently associated with post-operative postprandial hypoglycemia, which is not the case with GLP-1RAs and, paradoxically, there is evidence that GLP-1RAs may reduce both the frequency and severity of postprandial hypoglycemia. Comparative trials of the long-term efficacy of bariatric surgery and GLP-1RAs are indicated.