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Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity

Published:September 08, 2020DOI:https://doi.org/10.1016/j.soard.2020.09.002

      Highlights

      • Bariatric surgery resulted in reduction of CVD events in youth with type 2 diabetes

      Abstract

      Background

      Cardiovascular disease (CVD) remains the leading cause of mortality in type 2 diabetes (T2D). Better interventions are needed to mitigate the high lifetime risk for CVD in youth T2D.

      Objective

      To compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D.

      Setting

      Longitudinal multicenter studies at University hospitals.

      Methods

      A secondary analysis of data collected from the participants with T2D enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS, n = 30) and participants of similar age and racial distribution from the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY, n = 63) studies was performed. Teen-LABS participants underwent metabolic bariatric surgery (MBS). TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression. A 30-year CVD event score developed by the Framingham Heart Study was the primary outcome, assessed at baseline (preoperatively for Teen-LABS), 1 year, and 5 years of follow-up.

      Results

      Participants with T2D from Teen-LABS (n = 30; mean ± SD age = 16.9 ± 1.3 yr; 70% female; 60% white; body mass index (BMI) = 54.4 ± 9.5 kg/m2) and TODAY (n = 63; 15.3 ± 1.3 yr; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m2) were compared. The likelihood of CVD events was higher in Teen-LABS versus TODAY at baseline (17.66 [1.59] versus 12.11 [.79]%, adjusted P = .002). One year after MBS, event risk was significantly lower in Teen-LABS versus TODAY (6.79 [1.33] versus 13.64 [0.96]%, adjusted P < .0001), and sustained at 5 years follow-up (adjusted P < .0001).

      Conclusion

      Despite higher pretreatment risk for CVD events, treatment with MBS resulted in a reduction in estimated CVD event risks, whereas medical therapy associated with an increase in risk among adolescents with T2D and severe obesity.

      Keywords

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      Linked Article

      • Why are adolescents with obesity and diabetes not having bariatric surgery earlier?
        Surgery for Obesity and Related DiseasesVol. 17Issue 1
        • Preview
          Adolescent obesity is a growing problem with nearly 17% of adolescents in the United States and 15% in Europe affected. This rise in obesity has been accompanied by a rapid growth in the numbers also being diagnosed with type 2 diabetes (T2D) with an increase of nearly 30% between 2001 and 2009 [1]. The implications of obesity and specifically T2D in adolescents are particularly concerning given the apparent acceleration of the disease process with early loss of β cell function accompanied by worsening glycaemia and earlier end organ damage compared to adults with a similar duration of disease [2,3].
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