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

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


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 languageEnglish (US)
Pages (from-to)23-33
Number of pages11
JournalSurgery for Obesity and Related Diseases
Issue number1
StatePublished - 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).


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

PubMed: MeSH publication types

  • Journal Article
  • Randomized Controlled Trial


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