Reversal of type 2 diabetes mellitus and improvements in cardiovascular risk factors after surgical weight loss in adolescents.

Abstract

OBJECTIVES:

Type 2 diabetes mellitus is associated with obesity, dyslipidemia, and hypertension, all well-known risk factors for cardiovascular disease. Surgical weight loss has resulted in a marked reduction of these risk factors in adults. We hypothesized that gastric bypass would improve parameters of metabolic dysfunction and cardiovascular risk in adolescents with type 2 diabetes mellitus.

PATIENTS AND METHODS:

Eleven adolescents who underwent Roux-en-Y gastric bypass at 5 centers were included. Anthropometric, hemodynamic, and biochemical measures and surgical complications were analyzed. Similar measures from 67 adolescents with type 2 diabetes mellitus who were treated medically for 1 year were also analyzed.

RESULTS:

Adolescents who underwent Roux-en-Y gastric bypass were extremely obese (mean BMI of 50 +/- 5.9 kg/m(2)) with numerous cardiovascular risk factors. After surgery there was evidence of remission of type 2 diabetes mellitus in all but 1 patient. Significant improvements in BMI (-34%), fasting blood glucose (-41%), fasting insulin concentrations (-81%), hemoglobin A1c levels (7.3%-5.6%), and insulin sensitivity were also seen. There were significant improvements in serum lipid levels and blood pressure. In comparison, adolescents with type 2 diabetes mellitus who were followed during 1 year of medical treatment demonstrated stable body weight (baseline BMI: 35 +/- 7.3 kg/m(2); 1-year BMI: 34.9 +/- 7.2 kg/m(2)) and no significant change in blood pressure or in diabetic medication use. Medically managed patients had significantly improved hemoglobin A1c levels over 1 year (baseline: 7.85% +/- 2.3%; 1 year: 7.1% +/- 2%).

CONCLUSIONS:

Extremely obese diabetic adolescents experience significant weight loss and remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass. Improvements in insulin resistance, beta-cell function, and cardiovascular risk factors support Roux-en-Y gastric bypass as an intervention that improves the health of these adolescents. Although the long-term efficacy of Roux-en-Y gastric bypass is not known, these findings suggest that Roux-en-Y gastric bypass is an effective option for the treatment of extremely obese adolescents with type 2 diabetes mellitus.

• Authors: Thomas H Inge, Go Miyano, Judy Bean, Michael Helmrath, Anita Courcoulas, Carroll M Harmon, Mike K Chen, Kimberly Wilson, Stephen R Daniels, Victor F Garcia, Mary L Brandt, Lawrence M Dolan
• Journal: Pediatrics (Pediatrics) Vol. 123 Issue 1 Pg. 214-22 (Jan 2009) ISSN: 1098-4275 [Electronic] United States
• PMID: 19117885 (Publication Type: Comparative Study, Journal Article)

Topics

• Adolescent
• Cardiovascular Diseases (blood, etiology, prevention & control)
• Diabetes Mellitus, Type 2 (blood, complications, surgery)
• Female
• Gastric Bypass (methods, trends)
• Humans
• Male
• Obesity (blood, complications, surgery)
• Retrospective Studies
• Risk Factors
• Weight Loss (physiology)
• Young Adult