Abstract
OBJECTIVE To compare diabetic kidney disease (DKD) rates over 5 years of follow-up in two cohorts of severely obese adolescents with type 2 diabetes (T2D) undergoing medical or surgical treatment for T2D. RESEARCH DESIGN AND METHODS A secondary analysis was performed of data collected from obese participants of similar age and racial distribution enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) studies. 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. Glycemic control, BMI, estimated glomerular filtration rate (eGFR), urinary albumin excretion (UAE), and prevalence of hyperfiltration (eGFR ‡135 mL/min/1.73 m2) and elevated UAE (‡30 mg/g) were assessed annually. RESULTS Participants with T2D from Teen-LABS (n 5 30, mean 6 SD age, 16.9 6 1.3 years; 70% female; 60% white; BMI 54.4 6 9.5 kg/m2) and TODAY (n 5 63, age 15.3 6 1.3 years; 56% female; 71% white; BMI 40.5 6 4.9 kg/m2) were compared. During 5 years of follow-up, hyperfiltration decreased from 21% to 18% in Teen-LABS and increased from 7% to 48% in TODAY. Elevated UAE decreased from 27% to 5% in Teen-LABS and increased from 21% to 43% in TODAY. Adjusting for baseline age, sex, BMI, and HbA1c, TODAY participants had a greater odds of hyperfiltration (odds ratio 15.7 [95% CI 2.6, 94.3]) and elevated UAE (27.3 [4.9, 149.9]) at 5 years of follow-up. CONCLUSIONS Compared with MBS, medical treatment of obese youth with T2D was associated with a higher odds of DKD over 5 years.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 187-195 |
| Number of pages | 9 |
| Journal | Diabetes care |
| Volume | 43 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2020 |
Funding
Materials developed and used for the TODAY standard diabetes education program and the intensivelifestyleinterventionprogramareavail-able to the public at https://today.bsc.gwu.edu. A complete list of the members of the TODAY study group can be found in the Supplementary Data online. Materials developed and used for Teen-LABS are available to the public at www .teen-labs.org. Funding. The TODAY study was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). This work was completed with funding from NIDDK grants K23-DK-116720, U01-DK-61212, U01-DK-61230, U01-DK-61239, U01-DK-61242, and 01-DK-61254 and from National Center for Research Resources General Clinical Research Centers Program grants M01-RR-00036 (Washington University School of Medicine), M01-RR-00043-45 (Children’s Hospital Los Angeles), M01-RR-00069 (University of Colorado Denver), M01-RR-00084 (Children’s Hospital of Pittsburgh), M01-RR-01066 (Massachusetts General Hospital), M01-RR-00125 (Yale University), and M01-RR-14467 (University of Oklahoma Health Sciences Center) and Clinical and Translational Science Awards UL1-RR-024134 (Children’s Hospital of Philadelphia), UL1-RR-024139 (Yale University), UL1-RR-024153 (Children’s Hospital of Pittsburgh), UL1-RR-024989 (Case Western Reserve University), UL1-RR-024992 (Washington University in St. Louis), UL1-RR-025758 (Massachusetts General Hospital), and UL1-RR-025780 (University of Colorado Denver). The Teen-LABS consortium is funded by cooperative agreements with the NIDDK through grants UM1-DK-095710 (C.X., principal investigator, University of Cincinnati) and UM1-DK-072493 (T.I., principal investigator, University of Colorado Denver).
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
- Advanced and Specialized Nursing
