Surgical Versus Medical Therapy for Kidney Disease in Adolescent T2D Patients

In this study, researchers compared diabetic kidney disease (DKD) rates over a five-year period between severely obese adolescent patients with type 2 diabetes (T2D) treated with medical versus surgical therapy. Data were collected from two cohorts: the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) studies. The Teen-LABS cohort underwent metabolic bariatric surgery (MBS), and the TODAY participants randomly received metformin alone or in combination with rosiglitazone or intensive lifestyle intervention. Patients underwent annual evaluation for glycemic control, body mass index (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). The Teen-LABS cohort had 30 patients with a mean (SD) age of 16.9 (1.3) years; 70% of the patients were female, 60% were white, and the mean BMI (SD) was 54.4 (9.5) kg/m2. The TODAY cohort included 63 patients with a mean (SD) age of 15.3 (1.3) years; 56% of patients were female, 71% were white, and the mean BMI (SD) was 40.5 (4.9) kg/m2. Over a five-year period, the Teen-LABS group saw a decrease from 21% to 18% in hyperfiltration, while the TODAY group saw an increase from 7% to 48%. Elevated UAE decreased in the Teen-LABS group (27% to 5%) and increased in the TODAY group (21% to 43%). In adjusted analyses, the TODAY group had greater odds of hyperfiltration (odds ratio 15.7 [95% CI 2.6–94.3]) and elevated UAE (27.3 [4.9–149.9]) at five-year follow-up. The authors concluded that five-year risk of DKD was greater in patients treated medically compared to operative patients.