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

Inge, Thomas H.; Laffel, Lori; Jenkins, Todd M.; Marcus, Marsha D.; Leibel, Natasha; Brandt, Mary L.; Haymond, Morey W.; Urbina, Elaine M.; Dolan, Lawrence M.; Zeitler, Philip; Consortia, Youth

doi:10.1001/jamapediatrics.2017.5763

Cited by 149 publications

(92 citation statements)

References 32 publications

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“…In addition, we found a decrease in the in-hospital postoperative complication rates to 2.0%. A recently published study conducting a secondary analysis of data previously collected by the Teen Longitudinal Assessment of Bariatric Surgery and Treatment Options of Type 2 Diabetes in Adolescents and Youth trials 4 found adolescents with severe obesity treated with MBS had better weight loss, glycemic control, and improvement of cardiovascular risk markers than those receiving medical treatment alone. Despite these findings, less than 0.04% of children and adolescents with severe obesity are treated with MBS each year.…”

Section: Discussion ∣mentioning

confidence: 99%

National Trends in the Use of Metabolic and Bariatric Surgery Among Pediatric Patients With Severe Obesity

et al. 2018

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Severe pediatric obesity (class II or higher; body mass index [calculated as weight in kilograms divided by height in meters squared] ≥120% above the 95th percentile or ≥35) is a national public health crisis affecting more than 4.5 million children and adolescents in the United States. The prevalence of severe pediatric obesity has increased from 4.0% in 2000 to 6.0% in 2016. 1 For children and adolescents with this disease, metabolic and bariatric surgery (MBS) is effective in achiev ing long-term weight loss and resolution of comorbidities. 2,3 We sought to define contemporary trends in the use of MBS among US children, adolescents, and young adults with severe obesity.

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Section: Discussion ∣mentioning

confidence: 99%

National Trends in the Use of Metabolic and Bariatric Surgery Among Pediatric Patients With Severe Obesity

et al. 2018

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“…Furthermore, adolescence is a unique developmental period characterized by complex physiological and psychosocial changes and challenges that may complicate obesity management . Growing evidence supports the efficacy and safety of paediatric bariatric surgery . However, a better understanding of factors associated with successful surgical outcomes is warranted.…”

Section: Introductionmentioning

confidence: 99%

Early weight loss in adolescents following bariatric surgery predicts weight loss at 12 and 24 months

et al. 2019

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Summary Background Growing evidence supports the efficacy of paediatric bariatric surgery. However, there is a paucity of data examining adolescent outcomes post surgery. Among adults, studies have shown that early weight loss is associated with long‐term weight loss. Therefore, the aim of our study was to investigate the association between early weight loss at 3 months with longer‐term weight loss at 12 and 24 months in adolescents post surgery. We hypothesized that patients who have greater weight loss within the first 3 months will have greater weight loss at 12 and 24 months post surgery. Methods A retrospective chart review of bariatric surgery patients (n = 28) was conducted. Anthropometric measurements at baseline and 3, 12, and 24 months were analysed. Results Percent of excess weight loss (%EWL) at 3, 12, and 24 months were 33.6 ± 11.3%, 55.0 ± 20.5%, and 55.1 ± 27.1%, respectively. %EWL at 3 months was positively associated with %EWL at 12 and 24 months (P < 0.05). Receiver operating characteristic curve results identified a cut‐off of greater than or equal to 30%EWL at 3 months predicted successful weight loss, defined as greater than or equal to 50%EWL at 12 and 24 months. Conclusion These findings demonstrate that majority of weight loss among adolescents occurs within the first postoperative year. Greater %EWL by 3 months post surgery predicts successful and sustained weight loss over time.

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“…In a parallel analysis in youth-onset T2D who underwent bariatric surgery (Teen-LABS) vs. medical management (TODAY), the proportion of participants in Teen-LABS with elevated albumin excretion decreased from 26% to 5% over 2 yrs. Conversely, the prevalence of elevated albumin excretion did not change over time in TODAY (43). No data exist on the effect of bariatric surgery on hyperfiltration, intrarenal hemodynamic function, or renal O 2 in youth-onset T2D (Figure 4).…”

Section: Potential Novel Therapies For Hyperfiltrationmentioning

confidence: 88%

Renal Hyperfiltration in Adolescents with Type 2 Diabetes: Physiology, Sex Differences, and Implications for Diabetic Kidney Disease

Bjornstad

Cherney

2018

Curr Diab Rep

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Hyperfiltration is common in youth with T2D and predicts progressive DKD. Hyperfiltration is a consequence of early changes in intrarenal hemodynamic function, including increased renal plasma flow (RPF) and glomerular pressure. Girls with T2D are disproportionally affected by DKD, with a 3-fold greater risk of developing hyperfiltration over 5 years compared to boys. Despite the high prevalence and gravity of DKD in youth-onset T2D, widely effective therapeutic options are lacking. In this review, we focus on pathophysiology underlying early DKD in T2D and sex differences and summarize promising novel medical therapies and bariatric surgery.

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

Cited by 149 publications

References 32 publications

National Trends in the Use of Metabolic and Bariatric Surgery Among Pediatric Patients With Severe Obesity

National Trends in the Use of Metabolic and Bariatric Surgery Among Pediatric Patients With Severe Obesity

Early weight loss in adolescents following bariatric surgery predicts weight loss at 12 and 24 months

Renal Hyperfiltration in Adolescents with Type 2 Diabetes: Physiology, Sex Differences, and Implications for Diabetic Kidney Disease

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