When compared to medical therapies, a bariatric surgeon and an endocrinologist specializing in diabetes observed that the effectiveness of medical versus surgical intervention proved to be optimistic and effective.
The research, led by Thomas H. Inge, MD, PhD, director of the Bariatric Surgery Center at Children’s Hospital Colorado (Children’s Colorado), and Philip Zeitler, MD, PhD, chair of endocrinology at Children’s Colorado, is published in the March issue of JAMA Pediatrics. The recent study consisted of a secondary analysis of data from two longitudinal studies.
Led by Dr. Zeitler, the National Institutes of Health (NIH)-funded TODAY trial ran between 2004 and 2009, and included 699 adolescents with type 2 diabetes from 15 centers across the U.S. . Participants received metformin therapy alone or in combination with rosiglitazone. While addition of rosiglitazone to metformin reduced the loss of glycemic control by 23 percent, progression of diabetes was more rapid than in adults and neither medication prevented progression of diabetes or related complications, including cardiovascular risk and kidney damage.
Dr. Zeitler said “Because of this increase and the potential medical complications that can accompany this condition, therapies are urgently needed that will achieve better control over blood sugar levels than standard medical management has in studies to date.”
interpreted 242 adolescents who underwent bariatric surgery at five U.S. centers between 2007 and 2012. Thirty of the participants had type 2 diabetes at the time of their surgery. Data from this group of 30 was matched to 65 severely obese TODAY participants.
Comparison of the data revealed that adolescents with acute obesity and type 2 diabetes who received medical management experienced modest weight gain, progression of their type 2 diabetes, and no improvement in cardiovascular risk factors after two years. In contrast, the majority of adolescents who underwent surgical procedures in the Teen-LABS study experienced significant weight loss, normalization of blood glucose, and improvements in markers of cardiovascular health and kidney function over the same time period.
Dr. Inge stated “While we were examining a relatively small number of participants, our hope is these findings will be useful to those contemplating bariatric surgery for their adolescent patients. We still have much to learn about the long-term effects of surgery relative to medical therapy, but our hope is this research will open the door for longer-term assessments of health outcomes related to both types of treatments.”
The Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study was established in 2007 and is the only multicenter, NIH-sponsored research on adolescent bariatric surgery. Teen-LABS is an ongoing study involving six clinical centers around the U.S., including Children’s Hospital Colorado, Cincinnati Children’s Hospital Medical Center, Nationwide Children’s Hospital, Texas Children’s Hospital, the University of Alabama at Birmingham and the University of Pittsburgh Medical Center.