A team from Melbourne, Australia, examined the effect of health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding.
A total of 50 (17 men) patients with type 2 diabetes, from 500 consecutive patients, were studied preoperatively and again 1 year after surgery.
The mean preoperative weight and BMI were 137 kg and 48.2 kg/m2, respectively. At 1 year, weight and BMI were 110 kg and 38.7 kg/m2, respectively.
The researchers found that there was significant improvement in all measures of glucose metabolism.
Remission of diabetes occurred in 32 patients (64%). Major improvement of glucose control occurred in 13 patients (26%); glucose metabolism was unchanged in 5 patients (10%).
HbA1c was 7.8% preoperatively and 6.2% at 1 year.
|Outcomes 1 year after surgery:|
Remission of diabetes: 64%
Improved glucose control: 26%
No change: 10%
| Diabetes Care |
Greater weight loss and a shorter history of diabetes predicted remission of diabetes.
Improvement in diabetes was found to be related to increased insulin sensitivity and beta-cell function.
Weight loss was associated with significant improvements in fasting triglyceride level, HDL cholesterol level, hypertension, sleep, depression, appearance evaluation, and health-related quality of life.
Early complications occurred in 6% of patients (wound infections in 4%, respiratory support in 2%), and late complications occurred in 30% of patients (gastric prolapse in 20%, band erosion in 6%, and tubing leaks in 4%).
All late complications were successfully revised surgically.
John B. Dixon, of the Monash University Department of Surgery, Alfred Hospital, Melbourne, concluded on behalf of fellow authors, "Modern laparoscopic weight-loss surgery is effective in managing the broad range of health problems experienced by severely obese individuals with type 2 diabetes.
"Surgery should be considered as an early intervention."