Friday, May 25, 2012
Teens who underwent gastric bypass surgery showed dramatic, often immediate, remission of type 2 diabetes, many leaving the hospital without any diabetes-related medications, according to a new Cincinnati Children’s Hospital Medical Center study in the January issue of Pediatrics.
Type 2 diabetes mellitus is a significant health problem that has traditionally been considered an adult disease. But half of all new pediatric diabetes diagnoses are type 2. It is widely believed this phenomenon is related to obesity and an underlying predisposition for the disease.
The Cincinnati Children’s study found that bariatric surgery, specifically Roux-en-Y gastric bypass, helped teens lose, on average, a third of their body weight and induced remission of the diabetes in all but one teen. The study also notes other health improvements, such as lower blood pressure and cholesterol levels.
Previous studies have shown frequent remission of type 2 diabetes in adults following bariatric surgery, but until now, little information was available for families considering surgical weight loss for adolescents.
The study found that in most cases, patients can come off diabetes medications by the time they leave the hospital following surgery, says Thomas Inge, MD, PhD, Surgical Director of the Cincinnati Children’s Surgical Weight Loss Program for Teens and lead author of the study.
“The results have been quite dramatic and to our knowledge, there are no other anti-diabetic therapies that result in more effective and long-term control than that seen with bariatric surgery,” says Dr. Inge.
The study reports results in 78 adolescents with type 2 diabetes. Eleven patients underwent gastric bypass surgery at one of five participating medical centers: Cincinnati Children’s, Texas Children’s Hospital, University of Florida, Children’s Hospital of Alabama and University of Pittsburgh Medical Center.
The remaining 67 patients were part of a comparison group at Cincinnati Children’s who received routine medical management for their diabetes, but did not receive surgical treatment of any kind.
Extremely obese teens who underwent bariatric surgery had an average 34 percent reduction in weight one year after surgery, with all but one seeing their type 2 diabetes go into remission. By comparison, obese teens who were medically managed saw their weight remain essentially the same (reduction of 1.6 percent), and all of those patients were still taking medication for their diabetes.
“While the exact molecular mechanism by which the dramatic remission of diabetes occurs is not yet fully understood, we know that surgery results in a dramatic change in the production of gut hormones, and a change particularly in the way sugar is handled by the pancreas,” says Dr. Inge.
Amanda Munson had type 2 diabetes when she came to the Surgical Weight Loss Program for Teens. Today, 20 months after minimally invasive gastric bypass surgery, Munson is a diabetes-free sophomore in college. While her blood sugar still fluctuates from time to time, she says it is easily controlled with a snack and rest.
“It is nice to not have to worry about carrying supplies and keeping my medication cold when I go somewhere,” says Munson. “It is a lot less hassle than what I had to deal with when I gave myself a minimum of three injections a day.”
Prior to surgery, Munson used a “pen” to administer insulin-like medication every time she ate, as well as any time her blood sugar was elevated between meals.
Although she has had to do some self-policing with certain foods that are not approved for her post-surgery diet, Munson says losing one-third of her weight and remaining diabetes free is well worth it.
Munson was also the first participant in the larger Teen-LABS research study, a project based at Cincinnati Children’s and funded in 2006 by the National Institutes of Health. Teen-LABS will collect and report on the outcome of 200 teens undergoing weight loss surgery nationwide.
“In addition to the impressive weight loss and type 2 diabetes results, patients undergoing the gastric bypass surgery also showed significant improvement in blood pressure, insulin, glucose, cholesterol and triglyceride levels.” Dr. Inge says. “This is significant for the health of these teens, as it gives them an optimistic outlook for their future cardiovascular health.”
It is important to note that bariatric surgery is not without risks, but Dr. Inge and his colleagues agree that the numerous benefits of such procedures will likely outweigh the risks for qualified surgical candidates.
Cincinnati Children's Hospital Medical Center is one of America's top three children's hospitals for general pediatrics and is highly ranked for its expertise in digestive diseases, respiratory diseases, cancer, neonatal care, heart care and neurosurgery, according to the annual ranking of best children's hospitals by U.S. News & World Report. One of the three largest children's hospitals in the U.S., Cincinnati Children's is affiliated with the University of Cincinnati College of Medicine and is one of the top two recipients of pediatric research grants from the National Institutes of Health.
For its achievements in transforming healthcare, Cincinnati Children's is one of six U.S. hospitals since 2002 to be awarded the American Hospital Association-McKesson Quest for Quality Prize ® for leadership and innovation in quality, safety and commitment to patient care. The hospital is a national and international referral center for complex cases, so that children with the most difficult-to-treat diseases and conditions receive the most advanced care leading to better outcomes.