Weight loss surgery compared to medication in obese teenagers with type 2 diabetes

US scientists claim weight loss surgery provides better initial health outcomes for obese adolescents with type 2 diabetes than taking medication.
Bariatric (weight loss) surgery is considered an extreme measure in treating obese people with type 2 diabetes. The forms of surgery used in the study are irreversible procedures and will therefore affect the children for the rest of their lives.
Researchers from Children’s Hospital Colorado examined 700 teenagers with type 2 diabetes who were recruited from 15 clinical centres across the US.
They wanted to investigate which medical therapies were the most effective for helping young people control their diabetes, so they looked at two trials: the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study and the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) trial.
As part of the studies participants were randomised to receive either metformin on its own or rosiglitazone as well as metformin, or receive one of two weight loss surgeries: Roux-en-Y gastric bypass or vertical sleeve gastrectomy.
The researchers discovered that severely obese adolescents with type 2 diabetes who were given metformin, combination therapy or lifestyle intervention only lost a moderate amount of weight and saw no improvement in their cardiovascular risk factors. Those who had undergone the surgery lost significant amounts of weight, experienced better blood sugar levels and had improved cardiovascular health and kidney function.
While the study appears to show benefits for bariatric surgery, the study involved only two years of follow-up and can only show initial outcomes. The long-term effects of bariatric surgery also need to be considered – people undergoing these forms of surgery have to change the way they eat for the rest of their lives while requiring daily supplements.
Considering that it is known that type 2 diabetes in adults can be put into remission by eating a low carbohydrate diet and getting regular exercise, it may be a premature to see surgery being performed on youngsters before they have had a chance to address weight issues as adults.
There may be a case for bariatric surgery in children within certain circumstances, but this area of treatment requires significant consideration of the effects on physical and mental wellbeing in the years ahead of the children.
The findings have been published in JAMA Pediatrics.