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Tx Choice for T2DM in Obese Teens Tied to Later Kidney Disease Risk

Odds of diabetic kidney disease higher in obese teens receiving medical therapy versus bariatric surgery for T2DM

THURSDAY, Nov. 7, 2019 (HealthDay News) — For severely obese adolescents with type 2 diabetes (T2D), medical therapy is associated with increased odds of diabetic kidney disease (DKD) at five years compared with metabolic bariatric surgery, according to a study published online Nov. 4 in Diabetes Care.

Petter Bjornstad, M.D., from the University of Colorado Anschutz Medical Campus in Aurora, and colleagues conducted a secondary analysis of data collected from obese participants enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) study, who underwent metabolic bariatric surgery, and obese participants enrolled in the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) study, who were randomly assigned to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention. Thirty participants with T2D from Teen-LABS and 63 from TODAY were compared.

The researchers found that hyperfiltration decreased from 21 to 18 percent in Teen-LABS and increased from 7 to 48 percent in TODAY during five years of follow-up. In Teen-LABS, elevated urinary albumin excretion (UAE) decreased from 27 to 5 percent, while in TODAY, elevated UAE increased from 21 to 43 percent. At five years of follow-up, TODAY participants had increased odds of hyperfiltration and elevated UAE after adjustment for baseline age, sex, body mass index, and hemoglobin A1c (odds ratios, 15.7 and 27.3, respectively).

“Surgical treatment of severely obese youth with T2D is associated with substantially lower odds of DKD over five years of follow-up compared with standard medical therapy,” the authors write.

One author disclosed financial ties to the pharmaceutical industry; the TODAY Study Group received donations from several pharmaceutical companies.

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