For obese adolescents with T2D, bariatric surgery tops medical therapy

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Takeaway

  • Consider recommending bariatric surgery for obese adolescents with type 2 diabetes (T2D).

Why this matters

  • T2D has substantially increased in youth in recent years, carrying long-term morbidity/mortality risk.  

Study design

  • Secondary analysis of patient data, 2 studies:
    • 30 patients aged ≤19 years from the Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) who underwent primary bariatric surgery.
    • 63 patients aged 10-17 years from Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) randomly assigned to metformin (eg, Glucophage) alone vs metformin plus rosiglitazone (eg, Avandia) or intensive lifestyle with insulin added, if necessary.
  •  Funding: NIH; universities.

Key results

  • During 2-year follow-up, BMI decreased by 29% in Teen-LABS vs 3.7% rise in TODAY participants, corresponding to 44.2 kg loss vs 5.8 kg gain (P<.001>
  • Mean HbA1c decreased from 6.8% to 5.5% in Teens-LABS participants but increased from 6.4% to 7.8% in TODAY participants (P<.001>
  • BP also dropped in Teen-LABS and rose in TODAY participants (P=.02 for both systolic and diastolic differences).
  • Complications related/possibly related to surgery occurred in 23% in Teen-LABS participants.

Limitations

  • Secondary analysis, data from 2 studies.
  • Small study samples.
  • Few in Teen-LABS underwent increasingly-used vertical sleeve gastrectomy.
  • Not all follow-up visits completed.
  • No follow-up beyond 2 years.