Early gastric bypass improves odds of diabetes remission in teens

Type 2 diabetes patients who undergo gastric bypass surgery as teenagers are more likely to achieve remission of their diabetes and hypertension in adulthood than adults who attempt the same procedure years later, according to a study funded by the National Institutes of Health.

Though bariatric surgery is typically performed in a patient’s forties or fifties, a team led by Thomas H. Inge, MD, PhD, the director of adolescent bariatric surgery and chief of pediatric surgery at Children’s Hospital Colorado, found gastric bypass might benefit individuals most when they’re younger, before the cumulative effect of sustained obesity can pose a severe risk to their heart health.

“Some evidence also suggests...severely obese adults seeking bariatric surgery will be more likely to present with diabetes, hypertension, respiratory conditions, kidney dysfunction, walking limitation and venous edema in the legs and feet than adults seeking surgery who did not report severe obesity during adolescence,” Inge and colleagues wrote in the New England Journal of Medicine, where they published their findings May 16.

The team evaluated the health effects of Roux-en-Y gastric bypass in a cohort of 161 adolescents and 396 adults. Patients were enrolled from the Teen-LABS (Longitudinal Assessment of Bariatric Surgery) and LABS studies and followed for five years after their surgeries.

Overall, Inge et al. said weight loss percentage wasn’t different between groups—teens had lost 26% of their bodyweight five years after gastric bypass, while adults lost 29% of their bodyweight. Type 2 diabetes declined in both cohorts, but diabetic teens were 27% more likely than adults to have controlled blood glucose without the use of diabetes medications.

Prior to the study’s baseline, 88% of teens and 79% of adults needed diabetes medications to manage their disease. Five years later no teens were using diabetes meds, while just 26% of adults were doing the same. Use of blood pressure medications also decreased over the study period—from 57% to 11% in teens and from 68% to 33% in adults—and teens who previously had hypertension were 51% more likely than adults to have controlled their blood pressure by the end of the study.

“The significantly greater proportion of adolescents than adults with remission of hypertension would appear to provide additional evidence that adolescents have greater plasticity for reversal of complications of obesity than do adults,” the authors wrote. “Obesity-associated changes that are believed to contribute to the development of hypertension among adolescents may reflect a greater effect of surgery on reversible neurohumoral factors in youth.”

Inge and his co-authors said it wasn’t all good news for teenagers, though. They were more likely to face certain risks, including a need for subsequent abdominal surgeries like gallbladder removal, than their adult counterparts. Teens also had lower iron and vitamin D levels, possibly because they were less likely to take appropriate vitamin and mineral supplements post-op.

As with weight loss, death rates remained somewhat linear between the groups. Two teenagers died as the result of overdose, which the researchers said is troubling data given the results of a previous LABS study that found an increased risk of drug and alcohol abuse in adults after bariatric surgery.

“Two of the cause-specific deaths in the adolescent cohort appeared to be related to polysubstance abuse, a finding that is worrisome given the overall increasing trend of drug overdose deaths in the United States and in light of the increased risk of substance- and alcohol-use disorders reported in adults after gastric bypass surgery,” Inge et al. wrote. “Indeed, despite the small numbers of persons thus far affected by overdose after gastric bypass surgery, these findings may indicate a need for more focused research efforts, patient education and anticipatory guidance.”