Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes 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 6 SD age = 16.9 +/- 1.3 yr; 70% female; 60% white; body mass index (BMI) = 54.4 +/- 9.5 kg/m(2)) and TODAY (n 5 63; 15.3 +/- 1.3 yr; 56% female; 71% white; BMI 40.5 +/- 4.9 kg/m(2)) 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. (C) 2020 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Automated summary

A comparison of 30-year cardiovascular disease event risks in adolescents with type 2 diabetes and severe obesity undergoing different treatments revealed that metabolic bariatric surgery (MBS) can reduce the risk of cardiovascular events, while medical therapy may increase the risk among this population.