(HealthDay News) — For severely obese adolescents with type 2 diabetes (T2D), medical therapy is associated with increased odds of diabetic kidney disease (DKD) at 5 years compared with metabolic bariatric surgery, according to a study published online in Diabetes Care.

Petter Bjornstad, MD, 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% in Teen-LABS and increased from 7 to 48% in TODAY during 5 years of follow-up. In Teen-LABS, elevated urinary albumin excretion (UAE) decreased from 27 to 5%, while in TODAY, elevated UAE increased from 21 to 43%. At 5 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).

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“Surgical treatment of severely obese youth with T2D is associated with substantially lower odds of DKD over 5 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.


Bjornstad P, Hughan K, Kelsey MM, et al. Effect of Surgical Versus Medical Therapy on Diabetic Kidney Disease Over 5 Years in Severely Obese Adolescents With Type 2 Diabetes. Diab Care 2019 Oct; dc190708. doi:10.2337/dc19-0708