Early Intervention with Bariatric Surgery, Multi-Disciplinary Care More Effective at Curbing Obesity and Diabetes

New England Journal of Medicine Study Involving Cincinnati Children’s Adds to Evidence

Thursday, May 16, 2019

Doctors are learning the earlier in life that a person develops type 2 diabetes, the more aggressive the disease behaves. But they’re also learning that early intervention with treatments like gastric bypass surgery before adolescents become adults controls the disease and possibly throws it into remission.

Researchers at Cincinnati Children’s Hospital Medical Center are part of a new multi-center study published by The New England Journal of Medicine that adds dramatic evidence showing better health outcomes occur when patients undergo earlier intervention with gastric bypass surgery.

Results of the five-year outcomes study found that despite undergoing the same surgical procedures and achieving similar overall weight loss, adolescents experienced a significantly greater reversal of type 2 diabetes and high blood pressure than did adults after surgery.

Severe obesity now affects 4-6 million adolescents in the U.S. As a result, the health system is seeing dramatic increases in the many health complications caused by obesity in youth, including type 2 diabetes, said Michael Helmrath, MD, study co-investigator and director of Bariatric Surgery at Cincinnati Children’s.

“Early identification and treatment of type 2 diabetes in adolescents is critical to reducing the lifelong morbidity and mortality linked to the disease,” said Helmrath. “The disease is different in adolescents than adults. In many cases it progresses rapidly, even with medications. But despite their more aggressive form of type 2 diabetes, our study shows teens still have greater benefit from earlier interventions like bariatric surgery.”

The study’s major findings include:

• Overall weight loss between adolescents and adults was similar with 26 percent weight reduction in teens and 29 percent reduction in adults.
• Adolescents were 35 percent more likely to experience remission of type 2 diabetes than adults – for those with diabetes at baseline, 86 percent of adolescents and 53 percent of adults experienced remission five years after undergoing surgery.
• Adolescents were 51 percent more likely to experience remission of high blood pressure than adults – for those with high blood pressure at baseline, 68 percent of adolescents and 41 percent of adults experienced remission at five years.
• Adolescents underwent more subsequent abdominal operations and had lower iron and vitamin D stores than adults over the five years of the study. The types of subsequent operations that adolescents and adults underwent were similar, however.

Published online May 16 ahead of print, the study’s first author is Thomas H. Inge, MD, PhD, director of the Bariatric Surgery Center at Children’s Hospital Colorado and a former member of the medical staff at Cincinnati Children’s.

The study utilized data from two, consecutive longitudinal studies: the Longitudinal Assessment of Bariatric Surgery (LABS) and the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS). Teen-LABS was established in 2007 as an ongoing multicenter, NIH-sponsored research project on adolescent bariatric surgery. The current study included all six member medical centers in Teen-LABS.

T2D Center Part of Broader Solution

Cincinnati Children’s takes a holistic, multi-disciplinary approach to caring for obesity and type 2 diabetes. More invasive treatments like gastric bypass and other forms of bariatric surgery are considered appropriate for the most severely obese adolescents, or those with a body mass index of about 35 and above.

The Type 2 Diabetes Center at Cincinnati Children’s is designed to be a comprehensive care clinic, according to Amy Sanghavi Shah, MD, MS, a pediatric endocrinologist and center director. The clinic brings together a variety of experts ranging from endocrinologists, gastroenterologists, bariatric surgeons, dietitians, psychologists, exercise specialists and others.

The goal is to provide an integrated approach to treating type 2 diabetes and its potential complications. These complications can include high blood pressure, high cholesterol, fatty liver disease, menstrual irregularities in females and sleep apnea, according to Shah.

Research is Vital

Research programs that link to the center study certain why patients get type 2 diabetes and how different people respond in different ways to various treatments like bariatric surgery. Shah said the integrated process is expected to help the team understand more completely, and quickly, who might benefit the most from surgery. It also helps caregivers use other tailored treatments and even develop future treatments that may be able to mimic surgery noninvasively.

“The center’s comprehensive approach allows us to study and compare outcomes in new ways that otherwise wouldn’t be possible,” said Shah. “This includes treatment adherence, the best treatments for diabetes control such as medications or surgery, potential diabetes complications, mental health outcomes, and so on.”

One key finding from research linked to the center is that adolescents seem to have a higher rate adaptive plasticity than adults in their biology. That enhanced ability to change is what researchers suspect gives adolescents greater benefit from earlier interventions like diet, exercise, lifestyle changes and more extensive medical interventions like bariatric surgery.