Bariatric Surgery for Patients With Early-Onset vs Late-Onset Type 2 Diabetes

Aung, Lwin; Lee, Wei-Jei; Chen, Shu Chun; Ser, Kong-Han; Wu, Chun-Chi; Chong, Keong; Lee, Yi-Chih; Chen, Jung-Chien

doi:10.1001/jamasurg.2016.1130

Cited by 34 publications

(22 citation statements)

References 34 publications

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“…As these patients tend to have severe disease and more complications, metabolic surgery is especially worth in this group of patients. A recent study showed that young onset (<40 years age) T2DM Asian had more severe disease than late onset T2DM patients but had a better response to metabolic surgery [58]. This study highlighted the importance of metabolic surgery to be considered as priority for those Asian with young onset and poorly controlled T2DM.…”

Section: Predictors Of Diabetes Remission and Patient Selectionmentioning

confidence: 90%

Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia

Lee

Aung

2016

Diabetes Metab J

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Type 2 diabetes mellitus (T2DM) is a current global health priority and Asia is the epicenter of this epidemic disease. Unlike in the west, where older population is most affected, the burden of diabetes in Asian countries is disproportionately high in young to middle-age adults. The incidence of diabetic nephropathy is alarmingly high in patients with early onset T2DM, especially in those with poor glycemic control. How to control this chronic and debilitating disease is currently a very important health issue in Asia. Bariatric surgery has proven successful in treating not just obesity but also T2DM in morbid obese patients (body mass index [BMI] >35 kg/m2). Gastrointestinal metabolic surgery recently has been proposed as a new treatment modality for obesity related T2DM for patients with BMI <35 kg/m2. Many studies from Asia reported promising results of metabolic surgery to treat obese patients with T2DM which is not well controlled. It has been demonstrated that changes in gastrointestinal hormone secretion after gastrointestinal surgery would favor an early improvement of T2DM in Asians. New procedures have also been designed and proposed specifically for the treatment of diabetes in Asia. This article examines clinical trial data and accepted algorithms with a view toward elucidating the application of metabolic surgery for the treatment of T2DM in the Asia. We propose a systematic approach to surgical treatment, addressing current evidences, patient selection, procedure of choice, and timing and guideline for new procedures.

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Section: Predictors Of Diabetes Remission and Patient Selectionmentioning

confidence: 90%

Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia

Lee

Aung

2016

Diabetes Metab J

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“…With respect to diabetes resolution, several studies have similarly suggested that shorter duration of type 2 diabetes and higher preoperative C-peptide concentration are associated with greater diabetes resolution postoperatively 91 . Along with younger age, which has also been shown to be a positive predictor of better weight loss success 91 , 92 , this suggests that obese diabetic patients benefit from earlier intervention. These findings give credence to the argument that delaying bariatric surgery until individuals reach a BMI of more than 40 kg/m 2 may be counterproductive and actually be hurting more people in the end.…”

Section: Unanswered Questions and Future Investigationmentioning

confidence: 99%

Surgical treatment of obesity

Albaugh

Abumrad

2018

F1000Res

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Obesity prevalence continues to increase worldwide, as do the numerous chronic diseases associated with obesity, including diabetes, non-alcoholic fatty liver disease, dyslipidemia, and hypertension. The prevalence of bariatric surgery also continues to increase and remains the most effective and sustainable treatment for obesity. Over the last several years, numerous prospective and longitudinal studies have demonstrated the benefits of bariatric surgery on weight loss, mortality, and other chronic diseases. Even though the mechanisms underlying many of these beneficial effects remain poorly understood, surgical management of obesity continues to increase given its unmatched efficacy. In this commentary, we discuss recent clinical advancements as well as several areas needed for future research, including indications for bariatric and metabolic surgery, determination of responders and non-responders, metabolic surgery in non-obese individuals, and the evolving role of bariatric surgery in adolescents.

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“…This is concerning as young-onset type 2 diabetes (T2D) is an aggressive disease with increased risk of severe complications and high mortality [29]. Since bariatric surgery has proven effective for the remission and amelioration of young-onset T2D [30], this may indicate an underutilization of bariatric surgery in this particular sub-group, even within the wider context of a widespread underutilization of bariatric surgery, as highlighted among 14-25 year olds with obesity in the United States [31].…”

Section: Discussionmentioning

confidence: 99%

High estimated prevalence of bariatric surgery in young adults treated for pediatric obesity

Brissman

Lindberg

Beamish

et al. 2021

Surgery for Obesity and Related Diseases

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Background: Despite the modest effects of behavioral treatment on obesity in adolescence, bariatric surgery is rarely performed. Obesity often persists from childhood to adulthood, but it is not known how many individuals proceed with bariatric surgery in young adulthood. Objective: The aim of this study was to determine what proportion of individuals who received pediatric behavioral obesity treatment subsequently underwent bariatric surgery in early adulthood, and to identify predictors thereof. Setting: National registries, Sweden. Methods: In this prospective cohort study, the Swedish Childhood Obesity Treatment Register was linked to several national registers. Results: The childhood obesity cohort included 6502 (45% females) with a median age at follow-up of 21.7 years (interquartile range [IQR] 5.2). Of these, 8.2% underwent bariatric surgery at a median age of 20.9 years (IQR 4.2). The estimated cumulative incidence of bariatric surgery at age 30 was 21.5%. Obesity-related co-morbidities were identified in 31.7% before bariatric surgery in the childhood obesity cohort. Predictors of bariatric surgery were female sex, high body mass index standard deviation score (BMI SDS) at the start and end of treatment, poor treatment response, as well as own or parental cardiometabolic disease. Conclusions: More than a fifth are estimated to undergo bariatric surgery in early adulthood, despite having received pediatric behavioral obesity treatment. Our results indicate that for many children, behavioral treatment is insufficient in reducing obesity and preventing obesity-related co-morbidity. Therefore, it is reasonable to assume that more effective treatment of adolescents with severe obesity, including more rigorous behavioral support and pharmacologic treatment, but also more frequent use of bariatric surgery, would benefit this group of patients.

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Bariatric Surgery for Patients With Early-Onset vs Late-Onset Type 2 Diabetes

Abstract: This article describes the largest long-term study examining bariatric surgery for patients with early-onset T2DM. Bariatric surgery may achieve better and more long-lasting glycemic control in select patients with early-onset T2DM than in those with late-onset T2DM.

Cited by 34 publications

References 34 publications

Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia

Metabolic Surgery for Type 2 Diabetes Mellitus: Experience from Asia

Surgical treatment of obesity

High estimated prevalence of bariatric surgery in young adults treated for pediatric obesity

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