Surgical Treatment of Type 2 Diabetes Mellitus in Youth
Bariatric surgery is currently the most effective weight loss treatment of severe obesity and its associated comorbidities and is being increasingly used to treat children and adolescents with severe obesity, including those with Type 2 Diabetes (T2D). Th
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Surgical Treatment of Type 2 Diabetes Mellitus in Youth Anna Zenno
and Evan P. Nadler
Abstract
Bariatric surgery is currently the most effective weight loss treatment of severe obesity and its associated comorbidities and is being increasingly used to treat children and adolescents with severe obesity, including those with Type 2 Diabetes (T2D). This review focuses on the conventional management of T2D in children and adolescents, comparison of various types of bariatric surgeries, effect of bariatric surgery on gastrointestinal physiology and metabolism, current literature on the use of bariatric surgery to treat youth with severe obesity and T2D, and the potential complications of bariatric surgery in this population. Keywords
Bariatric surgery · Type 2 diabetes · Pediatric obesity · Vertical sleeve gastrectomy · Rouxen-Y gastric bypass · Adjustable gastric banding
A. Zenno (*) Division of Endocrinology, Children’s National Health System, Washington, DC, USA e-mail: [email protected] E. P. Nadler Division of Pediatric Surgery, Children’s National Health System, Washington, DC, USA The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
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Introduction
The incidence of type 2 diabetes (T2D) in youth (children and adolescents) has increased rapidly over the past 20 years and is expected to continue to rise in parallel with the global obesity epidemic as T2D is often a complication of obesity with over 85% of youth with T2D being overweight or obese at diagnosis (Pulgaron and Delamater 2014). In the United States, there are up to 5000 new cases of T2D in youth per year with economically disadvantaged racial/ethnic groups (African Americans, Hispanics, and Native American Indians) being most affected (Pettitt et al. 2014) and 1 of 5 adolescents (aged 12–18 years) have prediabetes (Andes et al. 2019). The data with respect to obesity are even more alarming: 35.1% of youth age 2–19 years are overweight (defined as BMI 85th percentile for age and sex); 19% have class I obesity (BMI 95th percentile); 6% have class II obesity (BMI 120% of the 95th percentile or BMI 35); and 2% have class III obesity (BMI 140% of the 95th percentile or BMI 40) per the National Health and Nutrition Examination Survey (NHANES), a nationally representative data source of over 3300 individuals (Skinner et al. 2018). Youth aged 12–19 are most affected by the disease, with a prevalence of overweight and obesity of 45% (Skinner et al. 2018). With no end in sight to reversing the obesity epidemic, it is likely that the number of new cases of T2D will continue to grow over the next several years. Thus, strategies
A. Zenno and E. P. Nadler
to prevent and treat T2D in youth are of vital importance. The diagnostic laboratory criteria for diabetes mellitus of any type in adults and youth is based on the presence of one or more of the following four determinants: fasting
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