Greater renal benefits seen with bariatric surgery vs. medications in pediatric type 2 diabetes, obesity
Adolescents with type 2 diabetes and obesity may be at lower risk for developing diabetic kidney disease if they receive bariatric surgery compared with medical treatment alone for diabetes, according to findings published in Diabetes Care.
“These data support bariatric surgery as a treatment alternative for severely obese youth with type 2 diabetes, and especially those with high risk for diabetic kidney disease,” Petter Bjornstad, MD, assistant professor of pediatrics and medicine in the division of renal diseases and hypertension at Children’s Hospital Colorado, told Endocrine Today. “Although bariatric surgery incurs a substantial initial cost, the benefit of bariatric surgery in youth-onset type 2 diabetes may outweigh the potential morbidity and initial costs for the carefully chosen patient in a specialized and experienced medical center.”
Bjornstad and colleagues analyzed data from 30 participants in the Teen-LABS study (mean age, 16.9 years; 70% girls; mean BMI, 54.4 kg/m2) and 63 participants in the TODAY study (mean age, 15.4 years; 55.6% girls; mean BMI, 40.5 kg/m2) who all had type 2 diabetes and obesity. The Teen-LABS participants represented those who received bariatric surgery, and the TODAY participants represented those who used medications only. The researchers recorded yearly data across 5 years on estimated glomerular filtration rate, urine albumin-to-creatinine ratio and blood pressure.
An eGFR of at least 135 mL/min/1.73 m2 was used to confirm hyperfiltration. Participants who had bariatric surgery saw a 3% reduction in hyperfiltration between baseline and 5 years compared with a 41% rise in hyperfiltration among those who used medications only (P = .04). The researchers also noted that incident hyperfiltration during the study and hyperfiltration at 5 years were more likely for those who used medications only vs. those who had bariatric surgery (OR = 21.2; 95% CI, 2.2-202.8 and OR = 17.2; 95% CI, 2.6-114.5, respectively).
A urine albumin-to-creatinine ratio of at least 30 µg/mg was used to confirm high urinary albumin excretion. Among participants who had bariatric surgery, there was a 22% reduction in this condition between baseline and 5 years compared with a 22% rise in the condition among those who used medications only (P = .003). The researchers also noted that high urinary albumin excretion was more likely to present at 5 years in those who used medications only vs. those who had bariatric surgery (OR = 27.3; 95% CI, 5.2-146.2).
Several metrics were used to identify hypertension, including reaching the 95th percentile or higher in systolic and diastolic BP. The researchers found that among participants who had bariatric surgery, there was a 23% reduction in hypertension between baseline and 5 years compared with a 40% rise in hypertension among the medication group (P = .0002). However, the researchers noted that the OR for hypertension when comparing the groups was not significant.
“Future studies are needed to determine the nephroprotective effects of gastric bypass vs. vertical sleeve gastrectomy in youth with type 2 diabetes,” Bjornstad said. “Future directions should also include translational studies dedicated to enhancing our understanding of the mechanisms of surgical benefit and identify potential novel non-surgical approaches to diabetic kidney disease in youth-onset type 2 diabetes.” – by Phil Neuffer
Disclosures: The TODAY study received support from Becton, Dickinson and Company, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, LifeScan, Pfizer and Sanofi Aventis. Bjornstad reports he has served as a consultant for Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Horizon Pharma, Novo Nordisk and Sanofi, and as an advisory board member for XORTX.