Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity

Justin R. Ryder, Peixin Xu, Kristen J. Nadeau, Megan M. Kelsey, Changchun Xie, Todd Jenkins, Thomas H. Inge, Petter Bjornstad

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Cardiovascular 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. Objective: To compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D. Setting: Longitudinal multicenter studies at University hospitals. Methods: A 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. Results: Participants 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). Conclusion: Despite 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.

Original languageEnglish (US)
Pages (from-to)23-33
Number of pages11
JournalSurgery for Obesity and Related Diseases
Volume17
Issue number1
DOIs
StatePublished - Jan 2021

Bibliographical note

Funding Information:
The research protocols of TODAY and Teen-LABS were approved by the relevant institutional review boards and all human participants gave written informed consent. The TODAY Study Group thanks the following companies for donations in support of the study's efforts: Becton, Dickinson and Company; Bristol-Myers Squibb; Eli Lilly and Company; GlaxoSmithKline; LifeScan, Inc.; Pfizer; Sanofi Aventis. We also gratefully acknowledge the participation and guidance of the American Indian partners associated with the clinical center located at the University of Oklahoma Health Sciences Center, including members of the Absentee Shawnee Tribe, Cherokee Nation, Chickasaw Nation, Choctaw Nation of Oklahoma, and Oklahoma City Area Indian Health Service. The opinions expressed in this paper are those of the authors and do not necessarily reflect the views of the respective Tribes or the Indian Health Service. Materials developed and used for the TODAY standard diabetes education program and the intensive lifestyle intervention program are available to the public at https://today.bsc.gwu.edu/. A complete list of the members of the TODAY Study Group can be found in the Supplementary Data online. Materials developed and used for the Teen-LABS are available to the public at https://teen-labs.org/. Drs. Xie and Xu are the guarantors of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Support, The TODAY study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH). This work was completed with funding from NIDDK/NIH grant numbers K23-DK116720, U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254; from the National Center for Research Resources General Clinical Research Centers Program grant numbers M01-RR00036 (Washington University School of Medicine), M01-RR00043-45 (Children's Hospital Los Angeles), M01-RR00069 (University of Colorado Denver), M01-RR00084 (Children's Hospital of Pittsburgh), M01-RR01066 (Massachusetts General Hospital), M01-RR00125 (Yale University), and M01-RR14467 (University of Oklahoma Health Sciences Center); and from the NCRR Clinical and Translational Science Awards grant numbers UL1-RR024134 (Children's Hospital of Philadelphia), UL1-RR024139 (Yale University), UL1-RR024153 (Children's Hospital of Pittsburgh), UL1-RR024989 (Case Western Reserve University), UL1-RR024992 (Washington University in St Louis), UL1-RR025758 (Massachusetts General Hospital), and UL1-RR025780 (University of Colorado Denver). NIDDK had no role in study design; collection, analysis, interpretation of data or in writing the report. The Teen-LABS consortium is funded by cooperative agreements with the NIDDK, through grants: UM1 DK072493 (PI, Dr. Thomas Inge, University of Colorado, Denver), and (PI, Dr. Changchun Xie, University of Cincinnati). Contributions, J.R. and P.B. wrote the manuscript and researched data, K.J.N. M.M.K. T.H.I. researched data and contributed to discussion and reviewed/edited the manuscript, T.J. contributed to analysis and discussion and reviewed/edited the manuscript, P.X. and C.X. were responsible for data analyses and contributed discussion and reviewed/edited the manuscript.

Funding Information:
The TODAY study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH). This work was completed with funding from NIDDK/ NIH grant numbers K23-DK116720, U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254; from the National Center for Research Resources General Clinical Research Centers Program grant numbers M01-RR00036 (Washington University School of Medicine), M01-RR00043-45 (Children’s Hospital Los Angeles), M01-RR00069 ( University of Colorado Denver ), M01-RR00084 (Children’s Hospital of Pittsburgh), M01-RR01066 ( Massachusetts General Hospital ), M01-RR00125 ( Yale University ), and M01-RR14467 (University of Oklahoma Health Sciences Center); and from the NCRR Clinical and Translational Science Awards grant numbers UL1-RR024134 (Children’s Hospital of Philadelphia), UL1-RR024139 (Yale University), UL1-RR024153 (Children’s Hospital of Pittsburgh), UL1-RR024989 ( Case Western Reserve University ), UL1-RR024992 (Washington University in St Louis), UL1-RR025758 (Massachusetts General Hospital), and UL1-RR025780 (University of Colorado Denver). NIDDK had no role in study design; collection, analysis, interpretation of data or in writing the report.

Funding Information:
The Teen-LABS consortium is funded by cooperative agreements with the NIDDK, through grants: UM1 DK072493 (PI, Dr. Thomas Inge, University of Colorado, Denver), and (PI, Dr. Changchun Xie, University of Cincinnati).

Publisher Copyright:
© 2020 American Society for Bariatric Surgery

Keywords

  • Cardiovascular disease
  • Medical therapy
  • Metabolic bariatric surgery
  • Prediction
  • Severe obesity
  • Type 2 diabetes

PubMed: MeSH publication types

  • Journal Article

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