Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity

Justin R. Ryder; Peixin Xu; Kristen J. Nadeau; Megan M. Kelsey; Changchun Xie; Todd Jenkins; Thomas H. Inge; Petter Bjornstad

doi:10.1016/j.soard.2020.09.002

Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity

Justin R. Ryder, Peixin Xu, Kristen J. Nadeau, Megan M. Kelsey, Changchun Xie, Todd Jenkins, Thomas H. Inge, Petter Bjornstad

Pediatrics - Pediatric Epidemiology

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Background: Cardiovascular disease (CVD) remains the leading cause of mortality in type 2 diabetes (T2D). Better interventions are needed to mitigate the high lifetime risk for CVD in youth T2D. Objective: To compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D. Setting: Longitudinal multicenter 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 (preoperatively for Teen-LABS), 1 year, and 5 years of follow-up. Results: Participants with T2D from Teen-LABS (n = 30; mean ± SD age = 16.9 ± 1.3 yr; 70% female; 60% white; body mass index (BMI) = 54.4 ± 9.5 kg/m²) and TODAY (n = 63; 15.3 ± 1.3 yr; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m²) were compared. The likelihood of CVD events was higher in Teen-LABS versus TODAY at baseline (17.66 [1.59] versus 12.11 [.79]%, adjusted P = .002). One year after MBS, event risk was significantly lower in Teen-LABS versus TODAY (6.79 [1.33] versus 13.64 [0.96]%, adjusted P < .0001), and sustained at 5 years follow-up (adjusted P < .0001). Conclusion: Despite higher pretreatment 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.

Original language	English (US)
Pages (from-to)	23-33
Number of pages	11
Journal	Surgery for Obesity and Related Diseases
Volume	17
Issue number	1
DOIs	https://doi.org/10.1016/j.soard.2020.09.002
State	Published - Jan 2021

Bibliographical note

Funding Information:
The TODAY study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH). This work was completed with funding from NIDDK/ NIH grant numbers K23-DK116720, U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254; from the National Center for Research Resources General Clinical Research Centers Program grant numbers M01-RR00036 (Washington University School of Medicine), M01-RR00043-45 (Children’s Hospital Los Angeles), M01-RR00069 ( University of Colorado Denver ), M01-RR00084 (Children’s Hospital of Pittsburgh), M01-RR01066 ( Massachusetts General Hospital ), M01-RR00125 ( Yale University ), and M01-RR14467 (University of Oklahoma Health Sciences Center); and from the NCRR Clinical and Translational Science Awards grant numbers UL1-RR024134 (Children’s Hospital of Philadelphia), UL1-RR024139 (Yale University), UL1-RR024153 (Children’s Hospital of Pittsburgh), UL1-RR024989 ( Case Western Reserve University ), UL1-RR024992 (Washington University in St Louis), UL1-RR025758 (Massachusetts General Hospital), and UL1-RR025780 (University of Colorado Denver). NIDDK had no role in study design; collection, analysis, interpretation of data or in writing the report.

Funding Information:
The Teen-LABS consortium is funded by cooperative agreements with the NIDDK, through grants: UM1 DK072493 (PI, Dr. Thomas Inge, University of Colorado, Denver), and (PI, Dr. Changchun Xie, University of Cincinnati).

Keywords

Cardiovascular disease
Medical therapy
Metabolic bariatric surgery
Prediction
Severe obesity
Type 2 diabetes

Access

10.1016/j.soard.2020.09.002

Fingerprint Dive into the research topics of 'Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity'. Together they form a unique fingerprint.

Cite this

Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity. / Ryder, Justin R.; Xu, Peixin; Nadeau, Kristen J.; Kelsey, Megan M.; Xie, Changchun; Jenkins, Todd; Inge, Thomas H.; Bjornstad, Petter.

In: Surgery for Obesity and Related Diseases, Vol. 17, No. 1, 01.2021, p. 23-33.

Research output: Contribution to journal › Article › peer-review

@article{1285326de7a84e0f887968cdda0e3266,

title = "Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity",

abstract = "Background: Cardiovascular disease (CVD) remains the leading cause of mortality in type 2 diabetes (T2D). Better interventions are needed to mitigate the high lifetime risk for CVD in youth T2D. Objective: To compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D. Setting: Longitudinal multicenter 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 (preoperatively for Teen-LABS), 1 year, and 5 years of follow-up. Results: Participants with T2D from Teen-LABS (n = 30; mean ± SD age = 16.9 ± 1.3 yr; 70% female; 60% white; body mass index (BMI) = 54.4 ± 9.5 kg/m2) and TODAY (n = 63; 15.3 ± 1.3 yr; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m2) were compared. The likelihood of CVD events was higher in Teen-LABS versus TODAY at baseline (17.66 [1.59] versus 12.11 [.79]%, adjusted P = .002). One year after MBS, event risk was significantly lower in Teen-LABS versus TODAY (6.79 [1.33] versus 13.64 [0.96]%, adjusted P < .0001), and sustained at 5 years follow-up (adjusted P < .0001). Conclusion: Despite higher pretreatment 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.",

keywords = "Cardiovascular disease, Medical therapy, Metabolic bariatric surgery, Prediction, Severe obesity, Type 2 diabetes",

author = "Ryder, {Justin R.} and Peixin Xu and Nadeau, {Kristen J.} and Kelsey, {Megan M.} and Changchun Xie and Todd Jenkins and Inge, {Thomas H.} and Petter Bjornstad",

note = "Funding Information: The TODAY study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH). This work was completed with funding from NIDDK/ NIH grant numbers K23-DK116720, U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254; from the National Center for Research Resources General Clinical Research Centers Program grant numbers M01-RR00036 (Washington University School of Medicine), M01-RR00043-45 (Children{\textquoteright}s Hospital Los Angeles), M01-RR00069 ( University of Colorado Denver ), M01-RR00084 (Children{\textquoteright}s Hospital of Pittsburgh), M01-RR01066 ( Massachusetts General Hospital ), M01-RR00125 ( Yale University ), and M01-RR14467 (University of Oklahoma Health Sciences Center); and from the NCRR Clinical and Translational Science Awards grant numbers UL1-RR024134 (Children{\textquoteright}s Hospital of Philadelphia), UL1-RR024139 (Yale University), UL1-RR024153 (Children{\textquoteright}s Hospital of Pittsburgh), UL1-RR024989 ( Case Western Reserve University ), UL1-RR024992 (Washington University in St Louis), UL1-RR025758 (Massachusetts General Hospital), and UL1-RR025780 (University of Colorado Denver). NIDDK had no role in study design; collection, analysis, interpretation of data or in writing the report. Funding Information: The Teen-LABS consortium is funded by cooperative agreements with the NIDDK, through grants: UM1 DK072493 (PI, Dr. Thomas Inge, University of Colorado, Denver), and (PI, Dr. Changchun Xie, University of Cincinnati). ",

year = "2021",

month = jan,

doi = "10.1016/j.soard.2020.09.002",

language = "English (US)",

volume = "17",

pages = "23--33",

journal = "Surgery for Obesity and Related Diseases",

issn = "1550-7289",

publisher = "Elsevier Inc.",

number = "1",

}

TY - JOUR

T1 - Effect of surgical versus medical therapy on estimated cardiovascular event risk among adolescents with type 2 diabetes and severe obesity

AU - Ryder, Justin R.

AU - Xu, Peixin

AU - Nadeau, Kristen J.

AU - Kelsey, Megan M.

AU - Xie, Changchun

AU - Jenkins, Todd

AU - Inge, Thomas H.

AU - Bjornstad, Petter

N1 - Funding Information: The TODAY study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK/NIH). This work was completed with funding from NIDDK/ NIH grant numbers K23-DK116720, U01-DK61212, U01-DK61230, U01-DK61239, U01-DK61242, and U01-DK61254; from the National Center for Research Resources General Clinical Research Centers Program grant numbers M01-RR00036 (Washington University School of Medicine), M01-RR00043-45 (Children’s Hospital Los Angeles), M01-RR00069 ( University of Colorado Denver ), M01-RR00084 (Children’s Hospital of Pittsburgh), M01-RR01066 ( Massachusetts General Hospital ), M01-RR00125 ( Yale University ), and M01-RR14467 (University of Oklahoma Health Sciences Center); and from the NCRR Clinical and Translational Science Awards grant numbers UL1-RR024134 (Children’s Hospital of Philadelphia), UL1-RR024139 (Yale University), UL1-RR024153 (Children’s Hospital of Pittsburgh), UL1-RR024989 ( Case Western Reserve University ), UL1-RR024992 (Washington University in St Louis), UL1-RR025758 (Massachusetts General Hospital), and UL1-RR025780 (University of Colorado Denver). NIDDK had no role in study design; collection, analysis, interpretation of data or in writing the report. Funding Information: The Teen-LABS consortium is funded by cooperative agreements with the NIDDK, through grants: UM1 DK072493 (PI, Dr. Thomas Inge, University of Colorado, Denver), and (PI, Dr. Changchun Xie, University of Cincinnati).

PY - 2021/1

Y1 - 2021/1

N2 - Background: Cardiovascular disease (CVD) remains the leading cause of mortality in type 2 diabetes (T2D). Better interventions are needed to mitigate the high lifetime risk for CVD in youth T2D. Objective: To compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D. Setting: Longitudinal multicenter 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 (preoperatively for Teen-LABS), 1 year, and 5 years of follow-up. Results: Participants with T2D from Teen-LABS (n = 30; mean ± SD age = 16.9 ± 1.3 yr; 70% female; 60% white; body mass index (BMI) = 54.4 ± 9.5 kg/m2) and TODAY (n = 63; 15.3 ± 1.3 yr; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m2) were compared. The likelihood of CVD events was higher in Teen-LABS versus TODAY at baseline (17.66 [1.59] versus 12.11 [.79]%, adjusted P = .002). One year after MBS, event risk was significantly lower in Teen-LABS versus TODAY (6.79 [1.33] versus 13.64 [0.96]%, adjusted P < .0001), and sustained at 5 years follow-up (adjusted P < .0001). Conclusion: Despite higher pretreatment 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.

AB - Background: Cardiovascular disease (CVD) remains the leading cause of mortality in type 2 diabetes (T2D). Better interventions are needed to mitigate the high lifetime risk for CVD in youth T2D. Objective: To compare 30-year risk for CVD events in 2 cohorts of adolescents with T2D and severe obesity undergoing medical or surgical treatment of T2D. Setting: Longitudinal multicenter 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 (preoperatively for Teen-LABS), 1 year, and 5 years of follow-up. Results: Participants with T2D from Teen-LABS (n = 30; mean ± SD age = 16.9 ± 1.3 yr; 70% female; 60% white; body mass index (BMI) = 54.4 ± 9.5 kg/m2) and TODAY (n = 63; 15.3 ± 1.3 yr; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m2) were compared. The likelihood of CVD events was higher in Teen-LABS versus TODAY at baseline (17.66 [1.59] versus 12.11 [.79]%, adjusted P = .002). One year after MBS, event risk was significantly lower in Teen-LABS versus TODAY (6.79 [1.33] versus 13.64 [0.96]%, adjusted P < .0001), and sustained at 5 years follow-up (adjusted P < .0001). Conclusion: Despite higher pretreatment 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.

KW - Cardiovascular disease

KW - Medical therapy

KW - Metabolic bariatric surgery

KW - Prediction

KW - Severe obesity

KW - Type 2 diabetes

UR - http://www.scopus.com/inward/record.url?scp=85092742051&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85092742051&partnerID=8YFLogxK

U2 - 10.1016/j.soard.2020.09.002

DO - 10.1016/j.soard.2020.09.002

M3 - Article

C2 - 33071178

AN - SCOPUS:85092742051

VL - 17

SP - 23

EP - 33

JO - Surgery for Obesity and Related Diseases

JF - Surgery for Obesity and Related Diseases

SN - 1550-7289

IS - 1

ER -