Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes

TLDR

Observational studies suggest that surgically induced weight loss may be an effective therapy for type 2 diabetes. The study aimed to determine whether surgically induced weight loss improves glycemic control and reduces the need for diabetes medications compared with conventional weight‑loss approaches. Sixty obese patients with newly diagnosed type 2 diabetes were randomized to either conventional diabetes therapy focused on lifestyle weight loss or laparoscopic adjustable gastric banding with standard diabetes care, with remission defined as fasting glucose <126 mg/dL and HbA1c <6.2% off medication, and weight and metabolic syndrome components were assessed. After two years, 73 % of the surgical group achieved remission versus 13 % of the conventional group (relative risk 5.5), the surgical group lost 20.7 % of body weight compared to 1.7 % in controls, remission correlated with weight loss and lower baseline HbA1c, and no serious complications occurred. Results are registered under ACTRN012605000159651 and require confirmation in larger, diverse cohorts.

Abstract

Observational studies suggest that surgically induced loss of weight may be effective therapy for type 2 diabetes.To determine if surgically induced weight loss results in better glycemic control and less need for diabetes medications than conventional approaches to weight loss and diabetes control.Unblinded randomized controlled trial conducted from December 2002 through December 2006 at the University Obesity Research Center in Australia, with general community recruitment to established treatment programs. Participants were 60 obese patients (BMI >30 and <40) with recently diagnosed (<2 years) type 2 diabetes.Conventional diabetes therapy with a focus on weight loss by lifestyle change vs laparoscopic adjustable gastric banding with conventional diabetes care.Remission of type 2 diabetes (fasting glucose level <126 mg/dL [7.0 mmol/L] and glycated hemoglobin [HbA1c] value <6.2% while taking no glycemic therapy). Secondary measures included weight and components of the metabolic syndrome. Analysis was by intention-to-treat.Of the 60 patients enrolled, 55 (92%) completed the 2-year follow-up. Remission of type 2 diabetes was achieved by 22 (73%) in the surgical group and 4 (13%) in the conventional-therapy group. Relative risk of remission for the surgical group was 5.5 (95% confidence interval, 2.2-14.0). Surgical and conventional-therapy groups lost a mean (SD) of 20.7% (8.6%) and 1.7% (5.2%) of weight, respectively, at 2 years (P < .001). Remission of type 2 diabetes was related to weight loss (R2 = 0.46, P < .001) and lower baseline HbA1c levels (combined R2 = 0.52, P < .001). There were no serious complications in either group.Participants randomized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss. These results need to be confirmed in a larger, more diverse population and have long-term efficacy assessed.actr.org Identifier: ACTRN012605000159651.