Aurora, Colo. (Dec. 10, 2020) - Cardiovascular disease is the leading cause of death in patients with type 2 diabetes, and youth with severe obesity and type 2 diabetes face a high risk of developing cardiovascular disease during their lifetime. However, in a recently published study in Surgery for Obesity and Related Diseases, researchers at Children's Hospital Colorado (Children's Colorado) determined that the long-term risk of cardiovascular events including heart attack, congestive heart failure, stroke and coronary death was reduced by almost threefold for teenagers with type 2 diabetes who underwent bariatric surgery compared to those whose diabetes was only managed medically.
"The incidence of youth-onset type 2 diabetes is increasing in the U.S., translating to premature mortality from cardiovascular disease and other chronic diseases such as diabetic kidney disease," said Petter Bjornstad, MD, an endocrinologist at Children's Colorado and one of the study's authors. "Bariatric surgery is currently the only treatment available for youth with severe obesity and type 2 diabetes that results in considerable and durable weight loss and improvement in blood sugar levels in the majority of patients. With this study, our intent was to further demonstrate the benefits of bariatric surgery in adolescents by proving that it also leads to significantly lower long-term risks of cardiovascular disease."
Specifically, the study compared the 30-year risk* for cardiovascular disease in two cohorts of adolescents with type 2 diabetes over a period of five years. The patients were participants in one of two multi-center studies led by researchers at Children's Colorado: Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY). The two groups included:
- 30 Teen-LABS participants, all of whom underwent bariatric surgery and had type 2 diabetes at the time of surgery
- 63 TODAY participants, all of whom had received medical treatment for type 2 diabetes
The Teen-LABS participants involved in the study had a significantly higher pre-treatment risk for cardiovascular disease than the TODAY participants, with higher blood pressure and cholesterol levels at the outset. However, the study revealed that treatment with bariatric surgery reduced the long-term risk of cardiovascular disease, whereas medical therapy alone was actually associated with an increase in risk among adolescents with type 2 diabetes and severe obesity.
The risk reduction due to bariatric surgery was attributed to improved blood sugar levels, weight loss, changes in blood pressure and an increase in HDL-C ("good" cholesterol) in the Teen-LABS patients.
"The high cardiovascular disease risk observed in TODAY participants, despite their lower baseline BMI, underscores the inadequacy of standard medical therapy in mitigating the risk of cardiovascular events, and calls for more aggressive therapy in this at-risk population," said Thomas H. Inge, MD, PhD, Teen-LABS principal investigator, and director of pediatric surgery and the bariatric center at Children's Colorado. "While longer-term studies are needed to determine whether the risk score predictions hold true, the long-term cardiovascular health prospects associated with bariatric surgery in adolescents appear to be very positive."
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Teen-LABS was established in 2007 and is the largest and only multicenter, National Institutes of Health (NIH)-sponsored research on adolescent bariatric surgery. This ongoing study involves six clinical centers around the U.S., including Children's Colorado, Cincinnati Children's Hospital Medical Center, Nationwide Children's Hospital, Texas Children's Hospital, Children's Hospital of Alabama and the University of Pittsburgh Medical Center.
The Teen-LABS consortium is funded by cooperative agreements with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), through grants: UM1DK072493 (PI, Dr. Thomas Inge, University of Colorado, Denver) and UM1DK095710 (PI, Dr. Changchun Xie, University of Cincinnati).
TODAY is the largest study of adolescents with type 2 diabetes to date. Led by Philip Zeitler, MD, PhD, chair of endocrinology at Children's Colorado, the NIH-funded TODAY trial was established in 2004, and included 699 adolescents with type 2 diabetes from 15 centers across the U.S. The study was aimed at determining which medical therapies were most effective at controlling type 2 diabetes in youth.
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.
* A 30-year cardiovascular disease event score developed by the Framingham Heart Study was the primary outcome metric, assessed at baseline (preoperatively for Teen-LABS), one year, and five years of follow-up.
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Children's Hospital Colorado is one of the nation's leading and most expansive pediatric healthcare systems with a mission to improve the health of children through patient care, education, research and advocacy. Founded in 1908 and recognized as a top ten children's hospital by U.S. News & World Report, Children's Colorado has established itself as a pioneer in the discovery of innovative and groundbreaking treatments that are shaping the future of pediatric healthcare worldwide. Children's Colorado offers a full spectrum of family-centered care at its urgent, emergency and specialty care locations throughout Colorado, including its location on the Anschutz Medical Campus, and across the region. In 2019, Children's Hospital Colorado, Colorado Springs, opened as the first pediatric-only hospital in southern Colorado. For more information, visit http://www.childrenscolorado.org, or connect with us on Facebook and Twitter.
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Journal
Surgery for Obesity and Related Diseases