medwireNews: Surgical treatment of severely obese adolescents with type 2 diabetes is associated with better glycaemic control and a greater reduction in BMI than medical management, US researchers report.

Bariatric surgery also resulted in reduced cardiovascular risk markers and improved kidney function whereas treatment with metformin alone or in combination with rosiglitazone had no impact on these variables.

“The striking differences in outcomes between these 2 treatments support consideration for surgical treatment for adolescents with severe obesity and type 2 diabetes,” Thomas Inge (Children’s Hospital Colorado, Aurora) and study co-authors remark.

But they caution that “the surgical treatment benefits were also associated with surgical risks.”

During 2 years of follow-up, mean glycated haemoglobin (HbA1c) concentration decreased from 6.8% to 5.5% in 30 participants of the Teen-LABS study (mean age at baseline, 16.9 years; mean BMI, 54.4 kg/m2) who underwent primary bariatric surgery.

By comparison, mean HbA1c increased from 6.4% to 7.8% in 63 participants of the TODAY study (mean age at baseline, 15.3 years; mean BMI 40.5 kg/m) who were randomly assigned to receive metformin therapy alone or in combination with either rosiglitazone or an intensive lifestyle intervention.

At 2 years, nearly all (94%) of the participants who underwent surgery had a HbA1c concentration below 6.5%, compared with just 38% of those who received medical management.

BMI fell by a mean 29.0% in the Teen-LABS participants but increased by 3.7% in the TODAY group. The corresponding mean weight changes were a loss of 44.2 kg versus a gain of 5.8 kg. The proportion of participants with elevated blood pressure more than halved (45 vs 20%) over time in the bariatric surgery group but nearly doubled (22 vs 41%) in the medical management group.

The numbers with dyslipidaemia, low estimated glomerular filtration rate, and elevated urinary albumin-creatinine ratio also fell substantially in the patients treated surgically but largely did not change in those treated medically.

Of note, 23% of Teen-LABS participants experienced complications related or possibly related to their surgery that needed a subsequent operation and/or readmission.

“These types of events should be understood by physicians, teenagers, and families when considering the treatment options currently available for adolescents with type 2 diabetes,” Inge and co-authors write in JAMA Pediatrics.

They conclude: “Future work in this cohort should focus on longer-term assessments of health outcomes, including nutritional and other effects of surgery, recurrence of type 2 diabetes, cardiovascular end points, and mortality.”

Laura Cowen

JAMA Pediatr 2018; Advance online publication

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