Comparison of surgical and medical therapy for type 2 diabetes in severely obese adolescents

Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) Consortia

Research output: Contribution to journalArticle

23 Citations (Scopus)

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 receivemetformin 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.

Original languageEnglish (US)
Pages (from-to)452-460
Number of pages9
JournalJAMA Pediatrics
Volume172
Issue number5
DOIs
StatePublished - May 1 2018

Fingerprint

Type 2 Diabetes Mellitus
Bariatric Surgery
Therapeutics
rosiglitazone
Body Mass Index

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

Cite this

Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) Consortia (2018). Comparison of surgical and medical therapy for type 2 diabetes in severely obese adolescents. JAMA Pediatrics, 172(5), 452-460. https://doi.org/10.1001/jamapediatrics.2017.5763
Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) Consortia. / Comparison of surgical and medical therapy for type 2 diabetes in severely obese adolescents. In: JAMA Pediatrics. 2018 ; Vol. 172, No. 5. pp. 452-460.
@article{7a501bc5fd0e4a6dad667ebab8947dfe,
title = "Comparison of surgical and medical therapy for type 2 diabetes in severely obese adolescents",
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 receivemetformin 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.",
author = "{Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) Consortia} and Inge, {Thomas H.} and Laffel, {Lori M.} and Jenkins, {Todd M.} and Marcus, {Marsha D.} and Leibel, {Natasha I.} and Brandt, {Mary L.} and Morey Haymond and Urbina, {Elaine M.} and Dolan, {Lawrence M.} and Zeitler, {Philip S.} and Siripoo McKay and Barbara Anderson and Cresendo Bush and Sheila Gunn and Heather Holden and Mary Jones and George Jeha and Sue McGirk and Sneha Thamotharan and Leona Cuttler and Ericka Abrams and Terri Casey and Bill Dahms and Carolyn Ievers-Landis and Beth Kaminski and Michaela Koontz and Sarah MacLeish and Paul McGuigan and Sumana Narasimhan and Mitchell Geffner and Veronica Barraza and Nancy Chang and Barry Conrad and Daina Dreimane and Silvia Estrada and Lynda Fisher and Evelyne Fleury-Milfort and Socorro Hernandez and Barbara Hollen and Francine Kaufman and Emily Law and Vanessa Mansilla and Debra Miller and Cynthia Mu{\~n}oz and Rosa Ortiz and Andriette Ward and Keren Wexler and Xu, {Y. K.} and Patrice Yasuda and Daniel Hale",
year = "2018",
month = "5",
day = "1",
doi = "10.1001/jamapediatrics.2017.5763",
language = "English (US)",
volume = "172",
pages = "452--460",
journal = "JAMA Pediatrics",
issn = "2168-6203",
publisher = "American Medical Association",
number = "5",

}

Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) Consortia 2018, 'Comparison of surgical and medical therapy for type 2 diabetes in severely obese adolescents', JAMA Pediatrics, vol. 172, no. 5, pp. 452-460. https://doi.org/10.1001/jamapediatrics.2017.5763

Comparison of surgical and medical therapy for type 2 diabetes in severely obese adolescents. / Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) Consortia.

In: JAMA Pediatrics, Vol. 172, No. 5, 01.05.2018, p. 452-460.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Comparison of surgical and medical therapy for type 2 diabetes in severely obese adolescents

AU - Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) Consortia

AU - Inge, Thomas H.

AU - Laffel, Lori M.

AU - Jenkins, Todd M.

AU - Marcus, Marsha D.

AU - Leibel, Natasha I.

AU - Brandt, Mary L.

AU - Haymond, Morey

AU - Urbina, Elaine M.

AU - Dolan, Lawrence M.

AU - Zeitler, Philip S.

AU - McKay, Siripoo

AU - Anderson, Barbara

AU - Bush, Cresendo

AU - Gunn, Sheila

AU - Holden, Heather

AU - Jones, Mary

AU - Jeha, George

AU - McGirk, Sue

AU - Thamotharan, Sneha

AU - Cuttler, Leona

AU - Abrams, Ericka

AU - Casey, Terri

AU - Dahms, Bill

AU - Ievers-Landis, Carolyn

AU - Kaminski, Beth

AU - Koontz, Michaela

AU - MacLeish, Sarah

AU - McGuigan, Paul

AU - Narasimhan, Sumana

AU - Geffner, Mitchell

AU - Barraza, Veronica

AU - Chang, Nancy

AU - Conrad, Barry

AU - Dreimane, Daina

AU - Estrada, Silvia

AU - Fisher, Lynda

AU - Fleury-Milfort, Evelyne

AU - Hernandez, Socorro

AU - Hollen, Barbara

AU - Kaufman, Francine

AU - Law, Emily

AU - Mansilla, Vanessa

AU - Miller, Debra

AU - Muñoz, Cynthia

AU - Ortiz, Rosa

AU - Ward, Andriette

AU - Wexler, Keren

AU - Xu, Y. K.

AU - Yasuda, Patrice

AU - Hale, Daniel

PY - 2018/5/1

Y1 - 2018/5/1

N2 - 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 receivemetformin 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.

AB - 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 receivemetformin 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.

UR - http://www.scopus.com/inward/record.url?scp=85046740894&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046740894&partnerID=8YFLogxK

U2 - 10.1001/jamapediatrics.2017.5763

DO - 10.1001/jamapediatrics.2017.5763

M3 - Article

C2 - 29532078

AN - SCOPUS:85046740894

VL - 172

SP - 452

EP - 460

JO - JAMA Pediatrics

JF - JAMA Pediatrics

SN - 2168-6203

IS - 5

ER -

Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) Consortia. Comparison of surgical and medical therapy for type 2 diabetes in severely obese adolescents. JAMA Pediatrics. 2018 May 1;172(5):452-460. https://doi.org/10.1001/jamapediatrics.2017.5763