Adolescent Gastric By-pass and Diabetic Precursors
Adolescent Gastric By-pass and Diabetic Precursors
The purpose of this research study is to find out what effects (good and bad) gastric bypass
 has on metabolism, including pancreatic insulin secretion. In addition, we will compare the
 effects of gastric bypass on the metabolism of adults and adolescents to try to determine
 whether there are greater metabolic and health advantages of performing gastric bypass
 earlier in life versus waiting until adulthood.
Overweight and obesity are the most common metabolic disorders affecting the U.S. with 31% of
 adults and 16% of adolescents now meeting Centers for Disease Control criteria for these
 conditions. As the obesity epidemic has unfolded, so too has the increase in prevalence of
 abnormalities of carbohydrate metabolism. The single most effective treatment for type 2
 diabetes in severely obese adults may be bariatric surgery, a procedure that is most commonly
 performed in the 5th and 6th decades of life. While it is clear that rapid and profound
 weight loss can significantly improve carbohydrate metabolism in adults, it is not clear to
 what degree type 2 diabetes is reversible in these patients. The pathophysiology of type 2
 diabetes in adolescents and children is not well understood and no studies have yet examined
 the effect of surgical weight loss on insulin resistance, insulin secretion, or glucose
 tolerance in severely obese young people. However, it seems likely that bariatric surgery
 could improve these conditions in youth. Understanding the relative benefits of surgically
 induced weight reduction on carbohydrate metabolism in adolescents compared to older subjects
 is important for determining optimal timing of this intervention. This knowledge may also
 lead to key insights into obesity-induced diabetes. In this project we will test the
 hypothesis that bariatric surgical intervention will more effectively improve insulin
 resistance, β cell dysfunction, and glucose tolerance in adolescents compared to adults.
 Three specific aims are proposed: 1) To compare the derangements of carbohydrate metabolism
 among very severely obese (body mass index ≥ 40 kg/m2) adolescents and adults referred for
 bariatric surgery; 2) To assess improvement in carbohydrate metabolism longitudinally (during
 and after surgical weight loss) comparing differences in the mechanisms of improvement
 between the two age groups; 3) To compare major complications in the two age groups following
 bariatric surgery. These data will provide critical information about age-related metabolic
 outcomes of bariatric surgery and could inform the design of larger studies to examine the
 role of early bariatric surgery in management of disorders related to insulin resistance in
 patients at high risk for these conditions.
Inclusion Criteria:

 -  Approved to be scheduled for laparoscopic gastric bypass surgery for VSO at Cincinnati
 Children's or University Hospital

 -  Age at time of gastric bypass surgery date >15 and <21 years, or >30 and <45 years

 -  BMI >40

 -  Weight at age 18 consistent with severe adolescent obesity (if height < 5'5" weight >
 200 pounds or if height >5'5", weight > 250)

 Exclusion Criteria:

 -  Diagnosis of cirrhosis, total bilirubin >1 mg/dL, prothrombin time > 13.3 sec

 -  Prior myocardial infarction

 -  Serum creatinine >1.7mg/dL

 -  Systemic (PO, IV, IM) glucocorticoid therapy within the previous six weeks prior to
 blood sampling

 -  Peri-menopausal (irregularity of menstrual periods over the past 3 months (67) or
 demonstrated abnormally high follicle stimulating hormone levels (68)

 -  Severe T2DM (on insulin for control of hyperglycemia, or HbA1c > 8.5)