ESPE Abstracts (2015) 84 WG2.7

The Rationale and Potential Role of Surgery in the Treatment of Adolescent Diabetes

Thomas H Inge

Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA

Background: Type 2 diabetes mellitus (T2DM) is a chronic and disabling disease affecting increasing numbers of adolescents. Conventional medical therapy presents unique challenges and seldom stalls progression.

Objective and hypotheses: The objective of this presentation is to discuss the findings of contemporary, controlled, and prospective trials of surgical therapy for adult T2DM, which demonstrate dramatic early glycemic control, improvement in cardiovascular risk factors, and impactful weight loss. However, in adults, the durability of the treatment response to surgical treatment may be limited, and influenced by duration and severity of the disease at the time of operation, leading to the hypothesis that surgery may more affectively arrest or reverse beta cell failure, cardiovascular, and renal damages if used earlier in life.

Conclusion: Based on the evidence in adults, it is appropriate to consider metabolic/bariatric surgery earlier in the treatment armamentarium for T2DM – and especially for select adolescents. However, well-designed prospective studies with hard endpoints that include a detailed assessment of target organ damage will be necessary to influence the place and timing of surgery in the treatment algorithm for adolescents.

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