OBJECTIVE To compare diabetic kidney disease (DKD) rates over 5 years of follow-up in two cohorts of severely obese adolescents with type 2 diabetes (T2D) undergoing medical or surgical treatment for T2D. RESEARCH DESIGN AND METHODS A secondary analysis was performed of data collected from obese participants of similar age and racial distribution enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) studies. Teen-LABS participants underwent metabolic bariatric surgery (MBS). TODAY participants were randomized to metformin alone or in combination with rosiglitazone or intensive lifestyle intervention, with insulin therapy given for glycemic progression. Glycemic control, 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) were assessed annually. RESULTS Participants with T2D from Teen-LABS (n = 30, mean ± SD age, 16.9 ± 1.3 years; 70% female; 60% white; BMI 54.4 ± 9.5 kg/m2) and TODAY (n = 63, age 15.3 ± 1.3 years; 56% female; 71% white; BMI 40.5 ± 4.9 kg/m2) were compared. During 5 years of follow-up, hyperfiltration decreased from 21% to 18% in Teen-LABS and increased from 7% to 48% in TODAY. Elevated UAE decreased from 27% to 5% in Teen-LABS and increased from 21% to 43% in TODAY. Adjusting for baseline age, sex, BMI, and HbA1c, TODAY participants had a greater odds of hyperfiltration (odds ratio 15.7 [95% CI 2.6, 94.3]) and elevated UAE (27.3 [4.9, 149.9]) at 5 years of follow-up. CONCLUSIONS Compared with MBS, medical treatment of obese youth with T2D was associated with a higher odds of DKD over 5 years.

中文翻译：

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手术与药物治疗对严重肥胖的2型糖尿病青少年在5年以上的糖尿病肾脏疾病的影响。

目的比较两个队列中接受药物或手术治疗的2型糖尿病（T2D）严重肥胖青少年的5年随访中糖尿病肾病（DKD）的发生率。研究设计和方法对从年龄相似和种族分布相似的肥胖参与者收集的数据进行了二次分析，这些数据参加了青少年减肥手术的青少年纵向评估（Teen-LABS）以及青少年的2型糖尿病的治疗选择（今日） ） 学习。青少年实验室参与者参加了代谢减肥手术（MBS）。今天的参与者被随机分配到二甲双胍单独使用或与罗格列酮或强化生活方式干预结合使用，并给予胰岛素治疗以促进血糖升高。血糖控制，BMI，估计的肾小球滤过率（eGFR），每年评估尿白蛋白排泄（UAE），超滤发生率（eGFR≥135mL / min / 1.73 m2）和阿联酋升高（≥30mg / g）。结果来自Teen-LABS的T2D参与者（n = 30，平均±SD年龄，16.9±1.3岁; 70％女性; 60％白人; BMI 54.4±9.5 kg / m2）和今天（n = 63，年龄15.3±1.3）年；女性56％；白人71％； BMI 40.5±4.9 kg / m2）进行了比较。在随访的5年中，Teen-LABS中的超滤从21％降低到18％，而今天则从7％增加到48％。在Teen-LABS中，高架阿联酋从27％下降至5％，而今天则从21％上升至43％。根据基线年龄，性别，BMI和HbA1c进行调整后，TODAY参与者在接下来的5年中发生超滤的几率更高（赔率15.7 [95％CI 2.6，94.3]）和阿联酋升高（27.3 [4.9，149.9]）。向上。结论与MBS相比，