Surgery may beat medical treatment for diabetic teens with severe obesity

Last Updated: 2018-03-15

By Anne Harding

NEW YORK (Reuters Health) - Severely obese adolescents with type 2 diabetes who undergo bariatric surgery fare better than those who receive standard medical management, according to an analysis of data from the Teen-LABS and TODAY studies.

Over two years of follow-up, BMI fell nearly 30% in the young people who had surgery, while it increased almost 4% in the medically managed group.

"This corresponded to a loss of 44 kg of body weight in Teen-LABS and a gain of 6 kg in the TODAY cohort," respectively, lead author Dr. Thomas H. Inge of Children's Hospital in Colorado told Reuters Health. "But even more importantly, surgery was superior at reversing type 2 diabetes in youth than medical treatments over those 2 years."

Over 5,000 people under 20 are diagnosed with type 2 diabetes every year in the U.S., Dr. Inge and his team note in JAMA Pediatrics, online March 12. The disease appears to progress faster in adolescents than adults, they add, with nearly half of teens requiring insulin within a year of diagnosis.

"There is a need to identify management approaches, including metabolic surgery, that may yield clinically significant and durable glycemic control," the researchers write.

They compared two years of follow-up data from the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) and the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) trials on severely obese teens with diabetes, including 63 TODAY participants and 30 Teen-LABS participants.

Mean hemoglobin A1C concentration fell from 6.8% to 5.5% in the surgery group, while it increased from 6.4% to 7.8% in the medical group. Waist circumference was reduced by 29 cm in the surgical group and increased by 4.3 cm in the TODAY participants.

The percentage of Teen-LABS participants who had elevated blood pressure had dropped from 45% at baseline to 20% at two years, while it increased from 22% to 41% in the TODAY group. Dyslipidemia prevalence fell from 72% to 24% in the surgical group and was unchanged in the medical group.

Seven of the Teen-LABS patients required additional surgery during the two-year follow-up period that may have been related to the previous bariatric surgery, such as gall bladder removal, while five others required subsequent hospitalization for observation or interventions that were not related to obesity surgery.

"What we took away from this is that surgical treatment of severely obese youth with type 2 diabetes was associated with significantly better glycemic control, reduced cardiovascular risk markers and improved kidney function," Dr. Inge said. At the three-year mark, he noted, about 90% of the Teen-LABS participants with type 2 diabetes at baseline had reversed the condition.

There are six bariatric centers that specialize in treating adolescents in the U.S., the researcher said, while some practices that treat adults will also treat younger people. "I would hasten to say that the adolescent centers that have the pediatric and adolescent medicine specialists are the places where the teenager will get the best consultation on the front end and particularly the best follow-up for those health conditions and for their obesity," Dr. Inge added.

He and his colleagues have already written a grant proposal to fund a "prospective, well-powered and long-term study to definitively demonstrate the role of surgery in adolescent type 2 diabetes," he added, and hope to begin the research this year.

SOURCE: http://bit.ly/2FEow7u

JAMA Pediatr 2018.