1135-OR: One-Year Outcomes from the Surgical or Medical Treatment for Pediatric Type 2 Diabetes (T2D): ST2OMP Study

Introduction and Objective: Roux-en-Y gastric bypass improves glycemia and BMI in youth-onset T2D (YO-T2D), whereas the TODAY & RISE studies showed poor glycemic and BMI responses to metformin, rosiglitazone, insulin and lifestyle intervention. Comparison data are lacking for both the more commonly performed vertical sleeve gastrectomy (VSG) and newer diabetes medications. We report the one-year primary outcome (PO, A1c <6%) in the ST2OMP prospective clinical trial comparing VSG to advanced medical therapy (AMT) in YO-T2D. Methods: BMI, A1c and co-morbidity resolution were compared pre/post-VSG (n=37) vs. AMT (n=48), defined as a multidrug treat-to-target approach using newer diabetes medications including GLP-1 receptor agonists and SGLT-2 inhibitors. Results: Baseline age, race/ethnicity, sex, A1c, number and type of medications were similar between groups, but BMI was higher (mean±SD 51.7±10.9 vs. 41.9±6.94 kg/m2) and diabetes duration shorter in the VSG vs. AMT group (0.8±0.8 vs. 1.9±1.80 yrs, both p<0.001). BMI (51.7±10.89 to 40.2±8.30 kg/m2, p<0.001) improved after VSG but was unchanged with AMT (BMI 41.9±6.94 to 40.9±6.92 kg/m2, p=0.56). At one year, despite similar BMI in both groups, 86% of VSG youth achieved the PO (A1c <6%) without diabetes medications, 58% had an A1c <5.7%, and 0% required >1 medication and median (IQR) A1c went from 6.1 [5.7, 7.1] to 5.5% [5.2, 5.8], p=0.07). Only 37.5% of AMT youth in achieved the PO, 86% still required >1 medication, 47% required 2+ medications and A1c went from 6.1 [5.7, 7.1] to 6.2% (5.7, 8.4), p=0.74). Only VSG youth significantly improved hepatic steatosis (MRI liver fat >5% 86.5 to 33.3%; p<0.01) and dyslipidemia from 38 to 14% (p<0.01). Conclusion: In YO-T2D, one year of AMT stabilized BMI and A1c, unlike previous treatments where both rose over time. VSG however led to greater BMI and A1c improvement and co-morbidity resolution vs. AMT, strongly supporting VSG use for YO-T2D treatment. Disclosure A. Shah: Consultant; Ended; AbbVie Inc. M. Moriarty Kelsey: Research Support; Current; Rhythm Pharmaceuticals, Inc. M. Helmrath: None. T. Inge: Consultant; Current; Teleflex, Medtronic. Other - Royalties/Patent Beneficiary; Current; Wolters Kluwer. Consultant; Current; Mediflix, Inc. Consultant; Ended; Brainstorm Cell Therapeutics. Consultant; Current; Eli Lilly and Company. T. Jenkins: None. S. Xanthakos: None. A.T. Trout: Consultant; Ended; GE Healthcare Systems. Research Support; Current; GE Healthcare Systems, Siemens, Perspectum. L. Browne: None. L.R. Schaaf: Advisory Panel; Ended; Novo Nordisk. A. Riegler: None. K. Witt: None. J.L. Hills-Dunlap: Other - Proctor; Current; Intuitive Surgical Inc.