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

Research output: Contribution to journalArticle

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

Fingerprint

Diabetic Nephropathies
Type 2 Diabetes Mellitus
Bariatric Surgery
Therapeutics
Albumins
rosiglitazone
Glomerular Filtration Rate
Metformin
Age Distribution

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., ... 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

Effect of surgical versus medical therapy on diabetic kidney disease over 5 years in severely obese adolescents with type 2 diabetes. / Bjornstad, Petter; Hughan, Kara; Kelsey, Megan M.; Shah, Amy S.; Lynch, Jane; Nehus, Edward; Mitsnefes, Mark; Jenkins, Todd; Xu, Peixin; Xie, Changchun; Inge, Thomas; Nadeau, Kristen.

In: Diabetes care, Vol. 43, No. 1, 01.01.2020, p. 187-195.

Research output: Contribution to journalArticle

Bjornstad, P, Hughan, K, Kelsey, MM, Shah, AS, 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, vol. 43, no. 1, pp. 187-195. https://doi.org/10.2337/dc19-0708
Bjornstad, Petter ; Hughan, Kara ; Kelsey, Megan M. ; Shah, Amy S. ; Lynch, Jane ; Nehus, Edward ; Mitsnefes, Mark ; Jenkins, Todd ; Xu, Peixin ; Xie, Changchun ; Inge, Thomas ; Nadeau, Kristen. / Effect of surgical versus medical therapy on diabetic kidney disease over 5 years in severely obese adolescents with type 2 diabetes. In: Diabetes care. 2020 ; Vol. 43, No. 1. pp. 187-195.
@article{708b1af227b74c6f939325b2ba3a3b90,
title = "Effect of surgical versus medical therapy on diabetic kidney disease over 5 years in severely obese adolescents with type 2 diabetes",
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.",
author = "Petter Bjornstad and Kara Hughan and Kelsey, {Megan M.} and Shah, {Amy S.} and Jane Lynch and Edward Nehus and Mark Mitsnefes and Todd Jenkins and Peixin Xu and Changchun Xie and Thomas Inge and Kristen Nadeau",
year = "2020",
month = "1",
day = "1",
doi = "10.2337/dc19-0708",
language = "English (US)",
volume = "43",
pages = "187--195",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "1",

}

TY - JOUR

T1 - Effect of surgical versus medical therapy on diabetic kidney disease over 5 years in severely obese adolescents with type 2 diabetes

AU - Bjornstad, Petter

AU - Hughan, Kara

AU - Kelsey, Megan M.

AU - Shah, Amy S.

AU - Lynch, Jane

AU - Nehus, Edward

AU - Mitsnefes, Mark

AU - Jenkins, Todd

AU - Xu, Peixin

AU - Xie, Changchun

AU - Inge, Thomas

AU - Nadeau, Kristen

PY - 2020/1/1

Y1 - 2020/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85077016831&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85077016831&partnerID=8YFLogxK

U2 - 10.2337/dc19-0708

DO - 10.2337/dc19-0708

M3 - Article

C2 - 31685489

AN - SCOPUS:85077016831

VL - 43

SP - 187

EP - 195

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 1

ER -