Cited by 189Bariatric Surgery and OutcomesDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

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Comparison of Surgical and Medical Therapy for Type 2 Diabetes in Severely Obese Adolescents

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Inge, Thomas H., Laffel, Lori M., Jenkins, Todd M., Marcus, Marsha D., Leibel, Natasha I., Brandt, Mary L., Haymond, Morey, Urbina, Elaine M., Dolan, Lawrence M., Zeitler, Philip S., for the Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) Consortia·2018·JAMA Pediatrics

DOI 10.1001/jamapediatrics.2017.5763PMC PMC5875354

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Abstract

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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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: Inge, Thomas H.
Laffel, Lori M.
Jenkins, Todd M.
Marcus, Marsha D.
Brandt, Mary L.
Haymond, Morey
Urbina, Elaine M.
Dolan, Lawrence M.
Zeitler, Philip S.
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
DOI: 10.1001/jamapediatrics.2017.5763
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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Comparison of Surgical and Medical Therapy for Type 2 Diabetes in Severely Obese Adolescents

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