Early weight-loss surgery in youth could reverse type 2 diabetes, blood pressure

Despite similar weight loss, teens who had gastric bypass surgery were significantly more likely to have remission of both type 2 diabetes and high blood pressure, compared to adults who had the same procedure. The national Institutes of Health, which funded the study, made the announcement, adding that previously, no treatment has shown longer-term effectiveness at reversing type 2 diabetes in youth, which tends to advance more quickly than in adults.

“Type 2 diabetes in youth has been a growing problem without a solution, hitting young adults with serious health conditions when they should be in the prime of their lives. This study demonstrates that bariatric surgery may provide an effective treatment, though not one without risks,” said Dr. Griffin P. Rodgers, Director of National Institute of Diabetes and Digestive and Kidney Diseases in the statement.

Researchers evaluated 161 teens and 396 adults who underwent this surgery at clinical centers participating in Teen-LABS (Teen-Longitudinal Assessment of Bariatric Surgery) and its adult counterpart, LABS. Teens in the study were under 19 years old at the time of surgery, and adults in the study reported having obesity by age 18. Teen-LABS clinical centers had specialized experience in the surgical evaluation and management of young people with severe obesity. The results were published in The New England Journal of Medicine.

“Obesity increases the risk for type 2 diabetes and cardiovascular diseases, and these conditions can be more difficult to manage in young people,” said Mary Evans, Ph.D., a study author and program director in the NIDDK Division of Digestive Diseases and Nutrition. “We found earlier bariatric surgery in carefully selected youth may have greater benefits compared to waiting until later in life.”

Key findings of the research include:

·   Overall weight loss percentage was not different between the groups. Teens lost 26 percent of their bodyweight and adults lost 29 percent at five years after surgery.

·   Type 2 diabetes declined in both groups, but teens with type 2 diabetes before surgery were 27 percent more likely than adults to have controlled blood glucose (blood sugar) without the use of diabetes medications.

·   No teens in the group needed diabetes medications after surgery, compared to 88 percent of teens before surgery. 79 percent of adults used diabetes medications before surgery, and 26 percent used diabetes medications five years later.

·   Before surgery, 57 percent of teens and 68 percent of adults used blood pressure medications. Five years after surgery, 11 percent of teens and 33 percent of adults used blood pressure medications.

·   Among those with high blood pressure before surgery, teens were 51 percent more likely than adults to no longer have high blood pressure or take blood pressure medication.

On the other hand, teens were more likely to have increased risks in other areas, including a need for subsequent abdominal surgeries, most commonly gall bladder removal. Teens were also more likely to have low iron and vitamin D levels, potentially because teens may be less likely to take enough vitamin and mineral supplements after surgery. There was a similar death rate for both teens and adults five years after surgery, including two people from the teen group who died from overdose. There is an overall increasing trend of drug overdose deaths in the U.S., and a previous LABS study found an increased risk of substance and alcohol use disorders after bariatric surgery in adults.

“Although there are risks associated with bariatric surgery, this study demonstrates that, for many young people, the benefits likely outweigh the risks,” said Thomas Inge, the study’s first author from Children’s Hospital Colorado, in the statement. “Sufficient vitamin and mineral supplementation, along with continued medical care, can help mitigate some of these risks.”