Teens with Diabetes and Severe Obesity May Be Better Off with Bariatric Surgery than Meds and Lifestyle Changes Alone

Published in April Issue             

Bariatric surgery may help teens with diabetes and severe obesity much more than medication and lifestyle changes alone, new NIH-funded research in the March 12 online issue of JAMA Pediatrics suggests.

The study involved 93 patients, 30 of whom had either laparoscopic gastric bypass or laparoscopic sleeve gastrectomy. The remaining patients were treated with the diabetes drugs metformin and/or rosiglitazone, and received lifestyle advice. Insulin treatment was provided as needed.

Adolescents with severe obesity and type 2 diabetes who received medical management experienced modest weight gain, progression of type 2 diabetes and no improvement in cardiovascular risk factors after two years. Most adolescents who had bariatric surgery in the Teen–Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study experienced significant weight loss (BMI decline of nearly 30 percent), diabetes remission and improved cardiovascular risk factors and kidney function – something not seen in those treated medically. Researchers noted that nearly one-quarter of the surgery patients needed a second operation within the two years.

In other findings among the teen bariatric surgery patients:

  • Mean HbA1c declined from 6.8% to 5.5% (normal is <5.7%) at two years
  • 94% had a HbA1c value in the non-diabetic range (<6.5 percent) at two years
  • The proportion of participants with an HbA1c in the ≥6.5 percent category decreased from 48% at baseline to 6% at two years
  • Nearly half (45%) had hypertension at baseline, which decreased to 20%
  • 72% had elevations of lipid levels at baseline, which decreased to 24%

Among study participants who did not have bariatric surgery, average BMI rose almost
4 percent, and HbA1C levels went from 6.4 percent to 7.8 percent on average.

Lead study author Thomas Inge, MD, PhD, director of the Bariatric Surgery Center at Children’s Hospital Colorado told HealthDay News, "Although these findings need to be replicated in a larger group of teenagers with diabetes, we can be optimistic that the surgery appears to achieve these benefits with no different surgical risk than when used in adults."

According to researchers, the study uncovered a need to find better ways to treat type 2 diabetes in teens, which may mean developing more family-based approaches to weight management or starting lifestyle programs at an even younger age.

Lori Laffel, MD

“Gastric bypass is something you want to enter thoughtfully. Patients and their family need to be aware that complications and the need for reoperation could occur, as well as the fact they will need to revise and transform their approach to eating,” said study coauthor Lori Laffel, MD, MPH, Chief, Pediatric, Adolescent and Young Adult Section at Joslin Diabetes Center, in a news release. “Our study suggests that if medical and lifestyle approaches fail, bariatric surgery should be considered.”

According to the Centers for Disease Control, 29.1 million people are living with diagnosed or undiagnosed diabetes, and about 208,000 people younger than 20 are living with
diagnosed diabetes.

The authors wrote in conclusion to their study: “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.”