Justin R Ryder1, Peixin Xu2, Kristen J Nadeau3, Megan M Kelsey3, Changchun Xie2, Todd Jenkins2, Thomas H Inge3, Petter Bjornstad4. 1. University of Minnesota Medical School and Center for Pediatric Obesity Medicine, Minneapolis, Minnesota, United States. 2. University of Cincinnati, Cincinnati Children's Medical Center, Cincinnati, Ohio, United States. 3. University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, United States. 4. University of Colorado Anschutz Medical Campus and Children's Hospital Colorado, Aurora, Colorado, United States. Electronic address: petter.bjornstad@childrenscolorado.org.
Abstract
BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of mortality in type 2 diabetes (T2D). Better interventions are needed to mitigate the high lifetime risk for CVD in youth T2D. OBJECTIVE: To compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D. SETTING: Longitudinal multicenter studies at University hospitals. METHODS: A secondary analysis of data collected from the participants with T2D enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS, n = 30) and participants of similar age and racial distribution from the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY, n = 63) studies was performed. Teen-LABS participants underwent metabolic bariatric surgery (MBS). TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression. A 30-year CVD event score developed by the Framingham Heart Study was the primary outcome, assessed at baseline (preoperatively for Teen-LABS), 1 year, and 5 years of follow-up. RESULTS: Participants with T2D from Teen-LABS (n = 30; mean ± SD age = 16.9 ± 1.3 yr; 70% female; 60% white; body mass index (BMI) = 54.4 ± 9.5 kg/m2) and TODAY (n = 63; 15.3 ± 1.3 yr; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m2) were compared. The likelihood of CVD events was higher in Teen-LABS versus TODAY at baseline (17.66 [1.59] versus 12.11 [.79]%, adjusted P = .002). One year after MBS, event risk was significantly lower in Teen-LABS versus TODAY (6.79 [1.33] versus 13.64 [0.96]%, adjusted P < .0001), and sustained at 5 years follow-up (adjusted P < .0001). CONCLUSION: Despite higher pretreatment risk for CVD events, treatment with MBS resulted in a reduction in estimated CVD event risks, whereas medical therapy associated with an increase in risk among adolescents with T2D and severe obesity.
BACKGROUND: Cardiovascular disease (CVD) remains the leading cause of mortality in type 2 diabetes (T2D). Better interventions are needed to mitigate the high lifetime risk for CVD in youth T2D. OBJECTIVE: To compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D. SETTING: Longitudinal multicenter studies at University hospitals. METHODS: A secondary analysis of data collected from the participants with T2D enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS, n = 30) and participants of similar age and racial distribution from the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY, n = 63) studies was performed. Teen-LABS participants underwent metabolic bariatric surgery (MBS). TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression. A 30-year CVD event score developed by the Framingham Heart Study was the primary outcome, assessed at baseline (preoperatively for Teen-LABS), 1 year, and 5 years of follow-up. RESULTS: Participants with T2D from Teen-LABS (n = 30; mean ± SD age = 16.9 ± 1.3 yr; 70% female; 60% white; body mass index (BMI) = 54.4 ± 9.5 kg/m2) and TODAY (n = 63; 15.3 ± 1.3 yr; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m2) were compared. The likelihood of CVD events was higher in Teen-LABS versus TODAY at baseline (17.66 [1.59] versus 12.11 [.79]%, adjusted P = .002). One year after MBS, event risk was significantly lower in Teen-LABS versus TODAY (6.79 [1.33] versus 13.64 [0.96]%, adjusted P < .0001), and sustained at 5 years follow-up (adjusted P < .0001). CONCLUSION: Despite higher pretreatment risk for CVD events, treatment with MBS resulted in a reduction in estimated CVD event risks, whereas medical therapy associated with an increase in risk among adolescents with T2D and severe obesity.
Authors: Thomas H Inge; Anita P Courcoulas; Todd M Jenkins; Marc P Michalsky; Mary L Brandt; Stavra A Xanthakos; John B Dixon; Carroll M Harmon; Mike K Chen; Changchun Xie; Mary E Evans; Michael A Helmrath Journal: N Engl J Med Date: 2019-05-16 Impact factor: 91.245
Authors: Thomas H Inge; Lori M Laffel; Todd M Jenkins; Marsha D Marcus; Natasha I Leibel; Mary L Brandt; Morey Haymond; Elaine M Urbina; Lawrence M Dolan; Philip S Zeitler Journal: JAMA Pediatr Date: 2018-05-01 Impact factor: 16.193
Authors: Petter Bjornstad; Kara Hughan; Megan M Kelsey; Amy S Shah; Jane Lynch; Edward Nehus; Mark Mitsnefes; Todd Jenkins; Peixin Xu; Changchun Xie; Thomas Inge; Kristen Nadeau Journal: Diabetes Care Date: 2019-11-04 Impact factor: 19.112
Authors: Phil Zeitler; Kathryn Hirst; Laura Pyle; Barbara Linder; Kenneth Copeland; Silva Arslanian; Leona Cuttler; David M Nathan; Sherida Tollefsen; Denise Wilfley; Francine Kaufman Journal: N Engl J Med Date: 2012-04-29 Impact factor: 91.245
Authors: Dana Dabelea; Ronny A Bell; Ralph B D'Agostino; Giuseppina Imperatore; Judith M Johansen; Barbara Linder; Lenna L Liu; Beth Loots; Santica Marcovina; Elizabeth J Mayer-Davis; David J Pettitt; Beth Waitzfelder Journal: JAMA Date: 2007-06-27 Impact factor: 56.272
Authors: Petter Bjornstad; Edward Nehus; Laure El Ghormli; Fida Bacha; Ingrid M Libman; Siripoom McKay; Steven M Willi; Lori Laffel; Silva Arslanian; Kristen J Nadeau Journal: Am J Kidney Dis Date: 2017-11-20 Impact factor: 8.860
Authors: Abdulghani H Al-Saeed; Maria I Constantino; Lynda Molyneaux; Mario D'Souza; Franziska Limacher-Gisler; Connie Luo; Ted Wu; Stephen M Twigg; Dennis K Yue; Jencia Wong Journal: Diabetes Care Date: 2016-03-22 Impact factor: 19.112
Authors: Lisa Gensthaler; Daniel M Felsenreich; Julia Jedamzik; Jakob Eichelter; Larissa Nixdorf; Christoph Bichler; Michael Krebs; Bianca Itariu; Felix B Langer; Gerhard Prager Journal: Obes Surg Date: 2022-01-18 Impact factor: 4.129