1181-P: Six-Month Outcomes of Vertical Sleeve Gastrectomy (VSG) vs. Advanced Medical Therapy (AMT) in Youth-Onset Type 2 Diabetes (YO-T2D)

Résumé fourni par la source

Introduction and Objective: Roux-en-Y gastric bypass (RYGB) improves glycemia and BMI in YO-T2D, whereas historical data from the TODAY and RISE studies showed poor glycemic and BMI responses to metformin, rosiglitazone, insulin and lifestyle treatment. Data are lacking on VSG, now the more common and better tolerated bariatric procedure in youth or comparing bariatric surgery to AMT with newer diabetes agents. Thus, we examined outcomes following VSG vs. AMT in the early postoperative period in the prospective Surgical or Medical Treatment for Pediatric T2D (ST2OMP) study. Methods: BMI and A1c were assessed pre-, 3 and 6 months-post VSG (n=37) vs. AMT (n=49), adjusting for baseline characteristics. Results: The cohort had a mean age of 16.7 yrs, T2D duration of 1.0 yr, A1c of 6.6%, BMI of 46 kg/m2, and was 55% female, 34% Black, 51% White, and 42% Hispanic. Baseline age, sex, race, ethnicity, and A1c were similar between the AMT and VSG groups, but T2D duration was shorter (0.5 [0,3.8] vs. 1.3 [0,8.5] years) and BMI higher (51.7±10.9 vs. 41.7±7.0 kg/m2) in youth undergoing VSG vs. AMT. BMI declined substantially with VSG (-19.2% [-21.2, -17.2]; p<0.001) and slightly with AMT (-1.8% [-3.5, -0.1]; p=0.035) at 6 mo. At 3 and 6 mo, BMI decline was greater in VSG vs. AMT (each p<0.001). A1c declined 3 mo post-VSG (-1.43 [-1.92, -0.93], p<0.001), which was sustained between 3 and 6 mo post-VSG (-1.55 [-2.07, -1.03], p=0.60). With AMT, A1c did not change at 3 (-0.06 [-0.49, 0.36], p=0.76) or 6 mo (+0.25 [-0.19, 0.69], p=0.10). Comparing treatments, at 3 and 6 mo, A1c lowering was greater following VSG, while off of diabetes medication, vs. AMT, while still on diabetes medication (p<0.001). Conclusion: In YO-T2D, 6 months of AMT stabilized BMI and A1c, unlike trials of older medical therapy where BMI and A1c rose over time. Yet, like RYGB, VSG allowed discontinuation of diabetes medications, plus greater BMI and A1c improvement than AMT, strongly supporting VSG for treating YO-T2D. Disclosure K.J. Nadeau: None. M.M. Kelsey: Research Support; Rhythm Pharmaceuticals, Inc. L.R. Schaaf: Advisory Panel; Novo Nordisk. A. Baumgartner: None. A. Riegler: None. K. Wiitala: None. T. Dobbs: None. S. Xanthakos: None. T.M. Jenkins: None. J.L. Hills-Dunlap: None. T. Inge: Consultant; Mediflix, UpToDate, Teleflex, Medtronic, Eli Lilly and Company, BrainStorm Cell Therapeutics, Standard Bariatrics. M. Helmrath: None. A.S. Shah: None. Funding NIDDK (R01DK119450)

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.