Effect of surgical versus medical therapy on diabetic kidney disease over 5 years in severely obese adolescents with type 2 diabetes

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

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Abstract

OBJECTIVE To compare diabetic kidney disease (DKD) rates over 5 years of follow-up in two cohorts of severely obese adolescents with type 2 diabetes (T2D) undergoing medical or surgical treatment for T2D. RESEARCH DESIGN AND METHODS A secondary analysis was performed of data collected from obese participants of similar age and racial distribution enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) studies. 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. Glycemic control, BMI, estimated glomerular filtration rate (eGFR), urinary albumin excretion (UAE), and prevalence of hyperfiltration (eGFR ‡135 mL/min/1.73 m2) and elevated UAE (‡30 mg/g) were assessed annually. RESULTS Participants with T2D from Teen-LABS (n 5 30, mean 6 SD age, 16.9 6 1.3 years; 70% female; 60% white; BMI 54.4 6 9.5 kg/m2) and TODAY (n 5 63, age 15.3 6 1.3 years; 56% female; 71% white; BMI 40.5 6 4.9 kg/m2) were compared. During 5 years of follow-up, hyperfiltration decreased from 21% to 18% in Teen-LABS and increased from 7% to 48% in TODAY. Elevated UAE decreased from 27% to 5% in Teen-LABS and increased from 21% to 43% in TODAY. Adjusting for baseline age, sex, BMI, and HbA1c, TODAY participants had a greater odds of hyperfiltration (odds ratio 15.7 [95% CI 2.6, 94.3]) and elevated UAE (27.3 [4.9, 149.9]) at 5 years of follow-up. CONCLUSIONS Compared with MBS, medical treatment of obese youth with T2D was associated with a higher odds of DKD over 5 years.

Original languageEnglish (US)
Pages (from-to)187-195
Number of pages9
JournalDiabetes care
Volume43
Issue number1
DOIs
StatePublished - Jan 1 2020

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ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Bjornstad, P., Hughan, K., Kelsey, M. M., Shah, A. S., Lynch, J., Nehus, E., Mitsnefes, M., Jenkins, T., Xu, P., Xie, C., Inge, T., & Nadeau, K. (2020). Effect of surgical versus medical therapy on diabetic kidney disease over 5 years in severely obese adolescents with type 2 diabetes. Diabetes care, 43(1), 187-195. https://doi.org/10.2337/dc19-0708