The Authors Reply:
Harmonized analyses in Teen-LABS and TODAY have demonstrated that bariatric surgery is associated with lower odds of diabetic kidney disease and cardiovascular disease compared with standard medical therapy.(1-3) We agree with Yang et al. that bariatric surgery holds promise to mitigate risk for long-term complications in young persons with obesity and type 2 diabetes, however weight loss surgery also carries potential risks worth emphasizing (e.g., possibility of the need for repeat surgery, the requirement for lifelong nutrient supplementation to prevent or treat dietary deficiencies, and deleterious implications on bone health, potential impacts on the offspring, as well as the increasingly recognized mental health burden). In the U.S. access to bariatric surgery may be further constrained by unequal insurance coverage.
We agree with Nelson et al. that their work in Pima people, have been instrumental in the understanding of the pathogenesis of complications in youth-onset type 2 diabetes, and especially diabetic kidney disease. Indeed, Determinants of Diabetic Nephropathy and the Diabetic Renal Disease Study provided seminal findings on the determinants of DKD in youth and adult-onset type 2 diabetes, which will be published in the future.
Footnotes
Since publication of their article, the authors report no further potential conflict of interest.
Contributor Information
Petter Bjornstad, University of Colorado School of Medicine, Denver, CO
Kimberly Drews, George Washington University, Rockville MD
Philip S. Zeitler, University of Colorado School of Medicine, Denver CO
References
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