Clinical

Gastric bypass may reverse type 2 diabetes in morbidly obese teens

Last Updated: 2008-12-29 1:00:08 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Type 2 diabetes usually resolves in extremely obese adolescents who undergo Roux-en-Y gastric bypass surgery, according to a case series of 11 such patients treated at five centers in the US.

The incidence of type 2 diabetes in adolescents has increased more than 10-fold over the last 2 decades, due in large part to the obesity epidemic, Dr. Thomas H. Inge, at Cincinnati Children's Hospital in Ohio, and co-authors note in the January 2009 issue of Pediatrics. "Thus, effective treatment options for adolescent obesity, insulin resistance, and diabetes are critically needed," they write.

Although adult studies clearly indicate that bariatric surgery can cause diabetes to go into remission, there have been no similar reports regarding diabetic adolescents. Dr. Inge's group compared outcomes among the 11 patients treated surgically with a control group of 67 adolescents with type 2 diabetes treated medically during the same period.

Mean body mass index at baseline in the surgical cohort was 50, and it declined by 34% after the first postsurgical year. Mean fasting glucose fell by 41%, and fasting insulin level declined by 81%. All patients but one no longer required medications to achieve glycemic control.

Surgery also led to improvement in blood pressure and lipid levels, as well as significant reductions in hepatic transaminases, "suggestive of improvement in fatty liver disease," the authors note.

By contrast, medically treated patients experienced no major changes in weight, blood pressure, or medication usage, the report indicates.

Although the surgical cohort remained markedly obese with a mean BMI similar to that of the control group (33 vs 35), "biochemical and medication use data strongly support the hypothesis Roux-en-Y gastric bypass surgery can result in remission of diabetes and dramatic improvement in metabolic health."

Noting that there is evidence that the frequency of remission of type 2 diabetes is inversely related to age at surgery, as well as duration and severity of disease, the authors suggest that "a greater benefit may be derived by reducing insulin resistance earlier in the course of type 2 diabetes mellitus to prevent beta-cell fatigue, perhaps before the requirement of insulin therapy."

Prospective studies in larger numbers of patients with longer follow-up will be required to verify this hypothesis, Dr. Inge and his team conclude.

Pediatrics 2009;123:214-222.