Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. 214-222 (doi:10.1542/peds.2008-0522)

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ARTICLE

Reversal of Type 2 Diabetes Mellitus and Improvements in Cardiovascular Risk Factors After Surgical Weight Loss in Adolescents

Thomas H. Inge, MD, PhD^a, Go Miyano, MD^a, Judy Bean, PhD^b, Michael Helmrath, MD^c, Anita Courcoulas, MD^d, Carroll M. Harmon, MD^e, Mike K. Chen, MD^f, Kimberly Wilson, MD^a, Stephen R. Daniels, MD^g, Victor F. Garcia, MD^a, Mary L. Brandt, MD^h and Lawrence M. Dolan, MDⁱ

Divisions of ^a Pediatric Surgery
ⁱ Endocrinology
^b Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
^c Departments of Surgery and Cell and Molecular Physiology, University of North Carolina, Chapel Hill, North Carolina
^d Division of Minimally Invasive Bariatric and General Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
^e Department of Surgery and Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, Alabama
^f Division of Pediatric Surgery, University of Florida, Gainesville, Florida
^g Department of Pediatrics, University of Colorado Health Sciences Center, Denver, Colorado
^h Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas

OBJECTIVES. Type 2 diabetes mellitus is associated with obesity, dyslipidemia, and hypertension, all well-known risk factors for cardiovascular disease. Surgical weight loss has resulted in a marked reduction of these risk factors in adults. We hypothesized that gastric bypass would improve parameters of metabolic dysfunction and cardiovascular risk in adolescents with type 2 diabetes mellitus.

PATIENTS AND METHODS. Eleven adolescents who underwent Roux-en-Y gastric bypass at 5 centers were included. Anthropometric, hemodynamic, and biochemical measures and surgical complications were analyzed. Similar measures from 67 adolescents with type 2 diabetes mellitus who were treated medically for 1 year were also analyzed.

RESULTS. Adolescents who underwent Roux-en-Y gastric bypass were extremely obese (mean BMI of 50 ± 5.9 kg/m²) with numerous cardiovascular risk factors. After surgery there was evidence of remission of type 2 diabetes mellitus in all but 1 patient. Significant improvements in BMI (–34%), fasting blood glucose (–41%), fasting insulin concentrations (–81%), hemoglobin A1c levels (7.3%–5.6%), and insulin sensitivity were also seen. There were significant improvements in serum lipid levels and blood pressure. In comparison, adolescents with type 2 diabetes mellitus who were followed during 1 year of medical treatment demonstrated stable body weight (baseline BMI: 35 ± 7.3 kg/m²; 1-year BMI: 34.9 ± 7.2 kg/m²) and no significant change in blood pressure or in diabetic medication use. Medically managed patients had significantly improved hemoglobin A1c levels over 1 year (baseline: 7.85% ± 2.3%; 1 year: 7.1% ± 2%).

CONCLUSIONS. Extremely obese diabetic adolescents experience significant weight loss and remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass. Improvements in insulin resistance, β-cell function, and cardiovascular risk factors support Roux-en-Y gastric bypass as an intervention that improves the health of these adolescents. Although the long-term efficacy of Roux-en-Y gastric bypass is not known, these findings suggest that Roux-en-Y gastric bypass is an effective option for the treatment of extremely obese adolescents with type 2 diabetes mellitus.

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Key Words: adolescent • type 2 diabetes mellitus • weight loss surgery • gastric bypass

Abbreviations: T2DM—type 2 diabetes mellitus • RYGB—Roux-en-Y gastric bypass • HOMA—homeostasis model assessment • HOMA2-IR—index of insulin resistance • HOMA2%S—index of insulin sensitivity • HOMA2-%B—index of β-cell function

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Accepted Apr 23, 2008.

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