title: Reversal of type 2 diabetes mellitus and improvements in cardiovascular risk factors after surgical weight loss in adolescents.
abstract: OBJECTIVE
  Type 2 diabetes mellitus is associated with obesity, dyslipidemia, and hypertension, all well-known risk factors for cardiovascular disease. Surgical weight loss has resulted in a marked reduction of these risk factors in adults. We hypothesized that gastric bypass would improve parameters of metabolic dysfunction and cardiovascular risk in adolescents with type 2 diabetes mellitus.
  
  
  METHODS
  Eleven adolescents who underwent Roux-en-Y gastric bypass at 5 centers were included. Anthropometric, hemodynamic, and biochemical measures and surgical complications were analyzed. Similar measures from 67 adolescents with type 2 diabetes mellitus who were treated medically for 1 year were also analyzed.
  
  
  RESULTS
  Adolescents who underwent Roux-en-Y gastric bypass were extremely obese (mean BMI of 50 +/- 5.9 kg/m(2)) with numerous cardiovascular risk factors. After surgery there was evidence of remission of type 2 diabetes mellitus in all but 1 patient. Significant improvements in BMI (-34%), fasting blood glucose (-41%), fasting insulin concentrations (-81%), hemoglobin A1c levels (7.3%-5.6%), and insulin sensitivity were also seen. There were significant improvements in serum lipid levels and blood pressure. In comparison, adolescents with type 2 diabetes mellitus who were followed during 1 year of medical treatment demonstrated stable body weight (baseline BMI: 35 +/- 7.3 kg/m(2); 1-year BMI: 34.9 +/- 7.2 kg/m(2)) and no significant change in blood pressure or in diabetic medication use. Medically managed patients had significantly improved hemoglobin A1c levels over 1 year (baseline: 7.85% +/- 2.3%; 1 year: 7.1% +/- 2%).
  
  
  CONCLUSIONS
  Extremely obese diabetic adolescents experience significant weight loss and remission of type 2 diabetes mellitus after Roux-en-Y gastric bypass. Improvements in insulin resistance, beta-cell function, and cardiovascular risk factors support Roux-en-Y gastric bypass as an intervention that improves the health of these adolescents. Although the long-term efficacy of Roux-en-Y gastric bypass is not known, these findings suggest that Roux-en-Y gastric bypass is an effective option for the treatment of extremely obese adolescents with type 2 diabetes mellitus.
authors.affiliation: Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. thomas.inge@cchmc.org
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Inge
authors.forename: Go
authors.initials: G
authors.lastname: Miyano
authors.forename: Judy
authors.initials: J
authors.lastname: Bean
authors.forename: Michael
authors.initials: M
authors.lastname: Helmrath
authors.forename: Anita
authors.initials: A
authors.lastname: Courcoulas
authors.forename: Carroll M
authors.initials: CM
authors.lastname: Harmon
authors.forename: Mike K
authors.initials: MK
authors.lastname: Chen
authors.forename: Kimberly
authors.initials: K
authors.lastname: Wilson
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Daniels
authors.forename: Victor F
authors.initials: VF
authors.lastname: Garcia
authors.forename: Mary L
authors.initials: ML
authors.lastname: Brandt
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Dolan
mesh_terms: D000293:Adolescent; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications / Q000601:surgery*; D005260:Female; D015390:Gastric Bypass / Q000379:methods / Q000639:trends*; D006801:Humans; D008297:Male; D009765:Obesity / Q000097:blood / Q000150:complications / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D015431:Weight Loss / Q000502:physiology*; D055815:Young Adult