Effect of Surgical versus Medical Therapy on Estimated Cardiovascular Event Risk Among Adolescents with Type 2 Diabetes and Severe Obesity

Abstract Objective To compare 30-year risk for cardiovascular disease (CVD) events in two cohorts of adolescents with type 2 diabetes (T2D) and severe obesity undergoing medical or surgical treatment of T2D. Setting Longitudinal multi-center studies at University hospitals Methods A secondary analysis of data collected from the participants with T2D enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS, n=30) and participants of similar age and racial distribution from the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY, n=63) studies was performed. 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. A 30-year CVD event score developed by the Framingham Heart Study was the primary outcome, assessed at baseline (pre-operatively for Teen-LABS), 1 and 5 years of follow-up. Results Participants with T2D from Teen-LABS (n=30, mean±SD age, 16.9±1.3 years; 70% female; 60% white; body mass index (BMI) 54.4±9.5 kg/m2) and TODAY (n=63, 15.3±1.3 years; 56% female; 71% white; BMI 40.5±4.9 kg/m2) were compared. The likelihood of CVD events was higher in Teen-LABS vs. TODAY at baseline (17.66 [1.59] vs. 12.11 [0.79]%, adjusted p=0.002). One year following MBS, event risk was significantly lower in Teen-LABS vs. TODAY (6.79 [1.33] vs. 13.64 [0.96]%, adjusted p Conclusions Despite higher pre-treatment risk for CVD events, treatment with MBS resulted in a reduction in estimated CVD event risks, whereas medical therapy associated with an increase in risk among adolescents with T2D and severe obesity.