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Diabetes remission linked to gastric banding surgery
Diabetes remission observed more in gastric bypass patients
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Patients with obesity and type 2 diabetes who had gastric banding surgery lost more weight and had an increased likelihood of diabetes remission compared with patients who used conventional methods of weight loss and diabetes control, according to findings from a recent study.
The researchers randomly assigned 60 obese patients to weight loss programs with conventional diabetes therapy focusing on weight loss through lifestyle change, or to laparoscopic adjustable gastric banding surgery with conventional diabetes care. Patients had a BMI .30 or ,40 and diabetes was diagnosed within two years.
Twenty-six patients experienced type 2 diabetes remission; four of the patients were in the conventional therapy group and 22 of the patients were in the surgery group, according to the researchers.
“After two years, the surgical group displayed a five times higher remission rate and four times greater reduction in HbA1c values than the conventional therapy group,” they said.
The gastric banding surgery group had a mean loss of body weight of 20% vs. 1.4% in the conventional therapy group. After two years, 24 patients in the surgery group had HbA1c levels ,6.2% compared with six patients in the conventional therapy group. The degree of weight loss, not the method, appeared to be the major driver of glycemic improvement and diabetes remission in patients with obesity, according to the researchers. – by Christen Haigh
For more information:
- Dixon JB, O’Brien PE, Playfair J, et al. Adjustable gastric banding and conventional therapy for type 2 diabetes. JAMA. 2008;299:316-323.
This study is significant in several ways. First, it is a randomized controlled trial, which is really what we, as doctors, want to see when we talk about evidence-based medicine. We have a high degree of confidence in the findings of this type of study. Second, for years we have focused on gastric bypass and called it the gold standard for weight loss and reversal of adult onset, insulin-dependent diabetes mellitus. The findings from this study verify that the lapband, which carries a fraction of the risk of bypass, is also an excellent treatment for diabetes. There are two other important points. The researchers accepted a number of patients who are merely obese (compared with morbidly obese), thus giving us a glimpse of what benefits we might achieve from earlier surgical intervention. Finally, this study was relatively short-term (two years). Most lapband patients have not yet reached their maximum weight loss at two years, so it is possible the success rate would go even higher with time. It is exciting.
– Frederick C. Finelli, MD, JD
President of the Medical Staff, Washington Hospital Center, Washington D.C.