By Alan Mozes
A small analysis found that bariatric surgery did a "far better" job than drug and lifestyle management in achieving significant weight loss and reversing diabetes, said study lead author Dr. Thomas Inge.
His investigation -- involving 93 teens in all -- found surgical treatment was associated with significantly better blood sugar control, reduced risk markers for heart disease and stroke, and improved kidney function.
This is important information because more than 5,000 Americans under age 20 are diagnosed with type 2 diabetes every year. And youth-onset diabetes appears more aggressive than diabetes diagnosed in adults, according to background notes with the study.
"During the last few decades, the prevalence of type 2 diabetes has substantially increased in the pediatric age groups," said Inge, chief of pediatric surgery at Children's Hospital Colorado in Aurora.
This is coupled with a fourfold increase in childhood obesity as well, he added.
Weight-loss surgery seem to have an edge over traditional obesity treatment for several reasons, Inge pointed out.
Type 2 diabetes in teens "is extremely difficult to treat," he said.
But "adult and animal studies of surgery for type 2 diabetes show that surgery not only decreases the size of the stomach but also results in a major change in pancreatic function and improvement in overall metabolism," Inge said.
Compliance is less of an issue, too. "You can't forget to take surgery every day as you can pills and insulin injections," he added.
Surgery also appears to do more to reduce insulin resistance, said Inge, and "to enhance the body's own ability to fight diabetes." It does this by improving signaling between the intestine, pancreas and liver, he noted.
"Medical treatments simply cannot do some of these things as effectively as surgical treatments," Inge said.
The researchers first analyzed a bariatric surgery study involving 30 patients age 19 or younger. All had type 2 diabetes and a body mass index (BMI) of 35 or more, which is severely obese (for example, a 5-foot-9 boy age 17 who weighs around 240 has a BMI of 35). All underwent either laparoscopic gastric bypass or laparoscopic sleeve gastrectomy.
Two years after surgery, the teens' BMI had declined nearly 30 percent on average. And their hemoglobin A1C levels -- a key indicator of diabetes severity -- dropped from 6.8 percent on average to 5.5 percent. However, nearly one quarter required a second surgery in that time frame.
The team then compared those results to the findings of another study in which 63 teens with type 2 diabetes were treated traditionally. Participants also had a BMI of 35 or higher at the study launch.
These teens were aggressively treated with the diabetes drugs metformin and/or rosiglitazone, and received lifestyle advice. Insulin treatment was provided as needed.
However, over the next two years, average BMI in this group jumped almost 4 percent. And their A1C levels crept up from 6.4 percent to 7.8 percent on average, according to the study.
And while blood pressure and kidney function improved among the surgery group, that was not the case with the medication group.
"Although these findings need to be replicated in a larger group of teenagers with diabetes, we can be optimistic that the surgery appears to achieve these benefits with no different surgical risk than when used in adults," Inge said.
All surgery comes with some risk, said Dr. William Heerman, an assistant professor of pediatrics at Vanderbilt University Medical Center in Nashville. He was not involved with the study.
Heerman said the findings confirm results already seen among adults with diabetes, but said "we don't yet know the long-term risks and benefits for adolescents undergoing bariatric surgery."
However, "the data presented today provide a compelling reason to give bariatric surgery careful consideration for adolescents with obesity and its complications," Heerman added.
The findings are in the March 12 online issue of JAMA Pediatrics.