NEPHROLOGY
The Comeback
Kidneys
Why does bariatric surgery help protect the kidneys in severely obese youth with type 2 diabetes?
Treatment methods to impede diabetic kidney disease in obese youth with type 2 diabetes are largely ineffective, save for one: weight loss surgery. Endocrinologist Petter Bjornstad, MD, is working to find out why that is and if there’ s a way to leverage its effects for patients who can’ t have surgery.
According to a U. S. renal data system report from 2016, diabetic kidney disease continues to be the leading cause of renal failure in the United States, accounting for approximately 45 % of all cases that progress to end-stage and dialysis. At a time when other common causes of end-stage kidney disease are not increasing in prevalence, says Petter Bjornstad, MD, that information is particularly disturbing, because it means more people— more adolescents— are developing type 2 diabetes. And compared to adult-onset type 2, youth-onset type 2 is markedly more difficult to treat.
“ We don’ t know why,” Dr. Bjornstad says,“ but youth with type 2 have a more aggressive phenotype with greater insulin resistance and more rapid beta cell failure. They also have a higher rate of complications including diabetic kidney disease. And not only higher rates, but also earlier onset. That’ s scary.”
Is surgical therapy a more effective treatment method for diabetic kidney disease than medical therapy in severely obese adolescents with type 2 diabetes?
Cohort
Severely obese adolescents with type 2 diabetes
BMI > 35
93 patients across two cohorts after frequency matching for race, sex, age, ethnicity
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