Comparison of Surgical and Medical Therapy for Type 2 Diabetes in Severely Obese Adolescents
Open accessAbstract
Importance: Because of the substantial increase in the occurrence of type 2 diabetes in the pediatric population and the medical complications of this condition, therapies are urgently needed that will achieve better glycemic control than standard medical management. Objective: To compare glycemic control in cohorts of severely obese adolescents with type 2 diabetes undergoing medical and surgical interventions. Design, Setting, and Participants: A secondary analysis of data collected by the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) consortia was performed. Teen-LABS enrolled 242 adolescents (≤19 years of age) from March 1, 2007, through December 31, 2011. TODAY randomized 699 participants (aged 10-17 years) from July 24, 2004, through February 25, 2009. Data analysis was performed from July 6, 2015, to June 24, 2017. Anthropometric, clinical, and laboratory data from adolescents with severe obesity and type 2 diabetes who underwent treatment with metabolic or bariatric surgery in the Teen-LABS study or medical therapy in the TODAY study were compared. Interventions: Teen-LABS participants underwent a primary bariatric surgical procedure; TODAY participants were randomized to receive metformin therapy alone or in combination with rosiglitazone or an intensive lifestyle intervention; insulin therapy was given in cases of progression of disease. Main Outcomes and Measures: Glycemic control, body mass index, prevalence of elevated blood pressure, dyslipidemia, abnormal kidney function, and clinical adverse events were measured. Results: Data from 30 participants from Teen-LABS (mean [SD] age at baseline, 16.9 [1.3] years; 21 [70%] female; 18 [66%] white) and 63 from TODAY (mean [SD] age at baseline, 15.3 [1.3] years; 28 [44%] female; 45 [71%] white) were analyzed. During 2 years, mean hemoglobin A1c concentration decreased from 6.8% (95% CI, 6.4%-7.3%) to 5.5% (95% CI, 4.7% -6.3%) in Teen-LABS and increased from 6.4% (95% CI, 6.1%-6.7%) to 7.8% (95% CI, 7.2%-8.3%) in TODAY. Compared with baseline, the body mass index decreased by 29% (95% CI, 24%-34%) in Teen-LABS and increased by 3.7% (95% CI, 0.8%-6.7%) in TODAY. Twenty-three percent of Teen-LABS participants required a subsequent operation during the 2-year follow-up. Conclusions and Relevance: Compared with medical therapy, surgical treatment of severely obese adolescents with type 2 diabetes was associated with better glycemic control, reduced weight, and improvement of other comorbidities. These data support the need for a well-designed, prospective controlled study to define the role of surgery for adolescents with type 2 diabetes, including health and surgical outcomes.
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MBS is safe in the population younger than 18 years and produces durable weight loss and improvement in co-morbid conditions.
“MBS is safe in the population younger than 18 years and produces durable weight loss and improvement in co-morbid conditions.”
From 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery (2023) · cites this paper as [54]
The Discussion reports weight loss and improvement in diabetes and cardiovascular risk factors over two years in adolescents with severe obesity and type 2 diabetes. But the Conclusion says long-term effects remain uncertain, and Clinical Adverse Events reports surgery-related or possibly related complications requiring another operation or readmission in 7 of 30 participants. The study therefore does not establish durable weight loss or unqualified safety for everyone younger than 18. (LLM, conf=0.90)
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- Authors
- Inge, T. H., Laffel, L. M., Jenkins, T. M., Marcus, M. D., Leibel, N. I., Brandt, M. L., Haymond, M., Urbina, E. M., Dolan, L. M., Zeitler, P. S., & Consortia, F. T. T. A. O. B. S. (.-L. A. T. O. O. T. 2. D. I. A. A. Y. (.
- Affiliations
- Children's Hospital Colorado (US)
- Joslin Diabetes Center (US)
- Cincinnati Children's Hospital Medical Center (US)
- University of Pittsburgh (US)
- Columbia University (US)
- Baylor College of Medicine (US)
- Corresponding author
- Inge, Thomas H.
- ORCID
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2018-05-01
- Volume
- 172
- Issue
- 5
- Pages
- 452
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC5875354
- OpenAlex
- W2792939285
- Cited by
- 189
- References
- 31
- Citations by year
- 2026: 11 · 2025: 27 · 2024: 21 · 2023: 24 · 2022: 18 · 2021: 30 · 2020: 26 · 2019: 19 · 2018: 13
- FWCI
- 22.87
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Children's Hospital of Philadelphia
- Children's Hospital Los Angeles
- Cincinnati Children's Hospital Medical Center
- National Institutes of Health (UL1TR001425, UL1TR000005, UL1TR000165, UL1TR000077, UL1TR002345)
- National Institute of Diabetes and Digestive and Kidney Diseases (UM1DK095710, UM1DK072493, U01DK061230, U01DK072493, P30DK036836)
- National Center for Research Resources (UL1RR024989, UL1RR025755, UL1RR025758, UL1RR024153, UL1RR024134, UL1RR024992, UL1RR024139, UL1RR025780)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- type 2 diabetes, adolescents, morbid obesity, bariatric surgery, metabolic surgery, metformin, rosiglitazone, lifestyle intervention, glycemic control, HbA1c, insulin therapy, insulin resistance, comorbidities, adverse events, weight loss
- MeSH terms
- Adolescent, Anthropometry, Blood Glucose, Child, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Longitudinal Studies, Male, Metformin, Obesity, Morbid, Body Mass Index, Bariatric Surgery
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