Diabetic kidney disease is the leading cause of kidney failure in the nation, and its occurrence in youth with type 2 diabetestype 2 diabetes is rapidly rising. Medical treatments are only partially effective. However, in a new study published online in Diabetes Care, researchers at Children's Hospital Colorado (Children's Colorado) have found that severely obese teens with type 2 diabetes experienced a dramatic decrease in the rate of diabetic kidney disease, among other benefits, after bariatric surgery when compared to those who received medical treatment alone.
"Diabetic kidney disease is increasing in prevalence each year as more and more people develop type 2 diabetes. Furthermore, youth-onset type 2 diabetes is much more aggressive than adult-onset type 2 diabetes, meaning adolescent patients have significantly higher rates of complications like diabetic kidney disease," said Petter Bjornstad, MD, an endocrinologist at Children's Colorado and lead author of the study. "Our current treatment options for these patients are suboptimal, and novel therapies are needed. With this study, we've been able to demonstrate for the first time that surgical treatment substantially lowers the odds of diabetic kidney disease for severely obese youth with type 2 diabetes compared to medical therapy."
In the study, Bjornstad and colleagues compared diabetic kidney disease rates among two cohorts of patients over a period of five years. The patients were participants in one of two multi-center studies led by researchers at Children's Colorado: Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY). Specifically, the two groups included:
- 63 TODAY participants, all of whom had received medical treatment for type 2 diabetes
- 30 Teen-LABS participants, all of whom underwent bariatric surgery and had type 2 diabetes at the time of surgery
Major findings of the five-year outcomes study included:
- The Teen-LABS study saw a 3% decrease in hyperfiltration over five years in participating adolescents, whereas TODAY participants saw a 41% increase. (With hyperfiltration, an early marker of diabetic kidney disease, the kidneys filter the blood at an abnormally high rate. Over time, hyperfiltration has been linked with progression of kidney disease in people with type 2 diabetes.)
- Teen-LABS participants saw a 22% decrease in elevated urinary albumin excretion (UAE) - or elevated protein levels in their urine, a key marker of kidney damage; TODAY participants had up to 27-fold greater odds of elevated UAE.
- Teen-LABS participants experienced a 23% decrease in high blood pressure; TODAY participants showed a 40% increase.
"This study further demonstrates that the benefits of bariatric surgery may outweigh the risks and initial costs for carefully chosen patients in a specialized, experienced medical center," said Thomas H. Inge, MD, PhD, Teen-LABS principal investigator, and director of pediatric surgery and the bariatric center at Children's Colorado. "While this study is incredibly promising, the initial cost and risks related to bariatric surgery should always be carefully considered."
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Teen-LABS was established in 2007 and is the largest and only multicenter, NIH-sponsored research on adolescent bariatric surgery. Teen-LABS is an ongoing study involving six clinical centers around the U.S., including Children's Hospital Colorado, Cincinnati Children's Hospital Medical Center, Nationwide Children's Hospital, Texas Children's Hospital, Children's Hospital of Alabama and the University of Pittsburgh Medical Center.
TODAY is the largest study of adolescents with type 2 diabetes to date. Led by Philip Zeitler, MD, PhD, chair of endocrinology at Children's Colorado, the National Institutes of Health (NIH)-funded TODAY trial was established in 2004, and included 699 adolescents with type 2 diabetes from 15 centers across the U.S. The study was aimed at determining which medical therapies were most effective at controlling type 2 diabetes in youth.
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.
The Teen-LABS consortium is funded by cooperative agreements with the NIDDK, through grants: UM1DK072493 (PI, Dr. Thomas Inge, University of Colorado, Denver), and UM1DK095710 (PI, Dr. Changchun Xie, University of Cincinnati).
About Children's Hospital Colorado
Children's Hospital Colorado is one of the nation's leading and most expansive pediatric healthcare systems with a mission to improve the health of children through patient care, education, research and advocacy. Founded in 1908 and recognized as a top children's hospital by U.S. News & World Report, Children's Colorado has established itself as a pioneer in the discovery of innovative and groundbreaking treatments that are shaping the future of pediatric healthcare worldwide. Children's Colorado offers a full spectrum of family-centered care at its urgent, emergency and specialty care locations throughout Colorado, including its location on the Anschutz Medical Campus, and across the region. The newly opened Children's Hospital Colorado, Colorado Springs, is now the first pediatric-only hospital in southern Colorado. For more information, visit http://www.childrenscolorado.org, or connect with us on Facebook and Twitter.
Children's Hospital Colorado complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.
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Journal
Diabetes Care