Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity |
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| Authors: | Justin R. Ryder Peixin Xu Kristen J. Nadeau Megan M. Kelsey Changchun Xie Todd Jenkins Thomas H. Inge Petter Bjornstad |
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| Affiliation: | 1. University of Minnesota Medical School and Center for Pediatric Obesity Medicine, Minneapolis, Minnesota, United States;2. University of Cincinnati, Cincinnati Children’s Medical Center, Cincinnati, Ohio, United States;3. University of Colorado Anschutz Medical Campus and Children’s Hospital Colorado, Aurora, Colorado, United States |
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| Abstract: | BackgroundCardiovascular 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.ObjectiveTo compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D.SettingLongitudinal multicenter studies at University hospitals.MethodsA 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.ResultsParticipants 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).ConclusionDespite 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. |
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| Keywords: | Type 2 diabetes Cardiovascular disease Prediction Severe obesity Metabolic bariatric surgery Medical therapy |
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