ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: Diabetes Care 2020;43(1):187–95. doi: 10.2337/dc19-0708

Short summary: Over 5 years follow-up, bariatric surgery compared with medical treatment resulted in dramatic attenuation of diabetic kidney disease (DKD) in adolescents with T2DM and severe obesity, beyond the impact of improved glycaemic control and weight loss.

Comment: DKD is the leading cause of end-stage renal disease and dialysis in the Western world. Adolescents with T2DM have significantly higher rates of DKD than adults with T2DM.¹ Renal hyperfiltration, as well as elevated urinary albumin excretion (UAE, i.e. microalbuminuria) are considered strong risk factors for the progression to end-stage renal disease, and may predict progressive DKD prior to the loss of renal function.

This study compared rates of DKD between two US cohorts over a period of 5 years. Thirty T2DM patients were participants of the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS), 24 underwent Roux-en-Y gastric bypass and 6 underwent vertical sleeve gastrectomy procedures. They were compared to 63 T2DM participants of the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY), who had received only medical treatment.

Hyperfiltration decreased from 21% to 18% in the surgical group (Teen-LABS), but increased from 7% to 48% in the medical treatment group (TODAY). Elevated UAE decreased from 27% to 5% in Teen-LABS, but increased from 21% to 43% in TODAY. TODAY participants had much higher odds of hyperfiltration and elevated UAE (15.7 and 27.3, respectively) at 5 years follow-up, after adjustment for baseline age, sex, body mass index and HbA1c. Teen-LABS participants showed a 23% decrease in high blood pressure, whereas TODAY participants showed a 40% increase. Mean HbA1c decreased from 6.8% to 5.9% at year 5 in Teen-LABS, but increased from 6.2% at baseline to 8.8% at year 5 in TODAY. Interestingly, participants in Teen-LABS had a higher mean BMI at baseline; however, at 5 years, BMI did not differ significantly between the groups.

Despite the obvious benefits of bariatric surgery, the authors also present its downside. This includes the requirement for lifelong nutrient supplementation to prevent or treat dietary deficiencies, deleterious implications on bone health, potential impacts on offspring, and the mental health burden. Indeed, 23% of Teen-LABS participants experienced complications that required subsequent operations and readmissions related to their bariatric surgery.

Reference:

1. Bjornstad P, Cherney DZ, Maahs DM, et al. Diabetic Kidney Disease in Adolescents With Type 2 Diabetes: New Insights and Potential Therapies. Current Diabetes Reports 2016;16(2):11. doi: 10.1007/s11892-015-0708-0 [published Online First: 2016/01/25]