Type 2 diabetes usually resolves in extremely obese adolescents who undergo weight loss surgery, according to a review of 11 such patients treated at five centers in the United States.

The number of teens with type 2 diabetes, also known as “adult onset” diabetes, has increased more than 10-fold over the last 2 decades, due in large part to the obesity epidemic, Dr. Thomas H. Inge, at Cincinnati Children’s Hospital in Ohio, and associates note in the January 2009 issue of Pediatrics.

Although adult studies clearly indicate that weight loss, or “bariatric,” surgery can cause diabetes to go into remission, there have been no similar reports regarding diabetic adolescents.

Inge’s group therefore compared outcomes among the adolescents with type 2 diabetes who underwent this procedure with those of a “control” group of 67 adolescents with type 2 diabetes who did not have surgery, but were treated medically.

With weight loss surgery, known as Roux-en-Y gastric bypass, a surgeon staples off the upper portion of the stomach to create a small pouch that restricts the amount of food a person can eat at one time. The surgeon also creates a bypass around the rest of the stomach and a portion of the small intestine, which limits the body’s absorption of food.

As expected, the adolescents who had the surgery lost a significant amount of weight; their average body mass index (BMI), the ratio of height to weight, before surgery was 50 and it declined by 34 percent in the first year after surgery. A normal BMI is considered to be between 18.5 and 24.9.

The patients’ average fasting glucose (blood sugar) fell by 41 percent, and fasting insulin level declined by 81 percent. All but one of the surgery patients no longer required medications to achieve good blood sugar control.

Surgery also led to improvements in blood pressure and cholesterol levels, as well as significant reductions in liver enzyme levels, “suggestive of improvement in fatty liver disease,” the authors note.

By contrast, the medically treated patients experienced no major changes in weight, blood pressure, or medication usage, the report indicates.

Although the surgical group remained markedly obese with an average BMI similar to that in the control group (33 vs 35), the biochemical data and the medication records strongly support the hypothesis that “Roux-en-Y gastric bypass surgery can result in remission of diabetes and dramatic improvement in metabolic health.”

Noting there is evidence that the frequency of remission of type 2 diabetes is inversely related to the patient’s age at surgery, as well as the duration and severity of disease, the authors suggest that “a greater benefit may be derived by reducing insulin resistance earlier in the course of type 2 diabetes mellitus to prevent beta-cell fatigue, perhaps before the requirement of insulin therapy.”

Prospective studies, or studies that follow patients as they begin the treatment process, with larger numbers of patients and longer follow-up periods are required to verify this hypothesis, Inge and his team conclude.

SOURCE: Pediatrics, January 2009.