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This study compares the effectiveness of vertical sleeve gastrectomy (VSG) versus advanced medical therapy (AMT) in improving diabetes management among youth with type 2 diabetes.

June 7, 2026

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

Key Points

This study compares the effectiveness of vertical sleeve gastrectomy (VSG) versus advanced medical therapy (AMT) in improving diabetes management among youth with type 2 diabetes.
Prospective clinical trial comparing outcomes in youth-onset type 2 diabetes with VSG (n=37) and AMT (n=48).
Evaluated baseline and one-year changes in BMI and A1c levels.
AMT included a multidrug treat-to-target approach with newer medications.
86% of VSG participants achieved the primary outcome (A1c <6%) without medications, compared to 37.5% in AMT.
VSG significantly improved BMI from 51.7 to 40.2 kg/m2 (p<0.001), whereas AMT had no significant change.
Only VSG showed significant improvement in hepatic steatosis and dyslipidemia.

Abstract

Introduction and Objective: Roux-en-Y gastric bypass improves glycemia and BMI in youth-onset T2D (YO-T2D), whereas the TODAY 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 p0.001). BMI (51.7±10.89 to 40.2±8.30 kg/m2, p0.001) 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%; p0.01) and dyslipidemia from 38 to 14% (p0.01). 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. A. Baumgartner: None. K. Wiitala: None. D. Winter: None. T.J. Dobbs: None. K.J. Nadeau: None. Funding NIH (R01 DK119450)

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

Key Points

Abstract

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