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Gastric Banding Achieves Sustained Weight Loss, Improvement in Diabetes

June 29, 2009 (Dallas, Texas) — Laparoscopic adjustable gastric banding has a sustained and substantial positive effect on metabolic parameters in morbidly obese patients with type 2 diabetes, according to data presented at the annual meeting of the American Society of Metabolic and Bariatric Surgery.

Investigators assessed the 5-year outcomes of 95 morbidly obese patients with type 2 diabetes, recording age, sex, race, body mass index (BMI), diabetes history, fasting glucose level, hemoglobin A1c (HbA1c), and use of medications. The patients underwent laparoscopic adjustable gastric banding between January 2002 and June 2004.

The mean preoperative BMI was 46.3, which fell to 35.0 at 5-year follow-up. Mean excess weight loss was 48.3%.

The mean fasting glucose level fell from 146 mg/dL to 118.5 mg/dL (P = .004). The mean HbA1c decreased from 7.53% to 6.58% at 5 years after banding (P < .0001).

Diabetes resolution occurred in 40% of 58 patients, with a further 40% of diabetics showing improvement, defined by fewer medications required and lower fasting glucose levels.

“Our study shows that for the vast majority of diabetic, morbidly obese patients, they will have improvement in their diabetes and often times a resolution of their diabetes, which extends out to 5 years,” said Christine Ren, MD, FACS, an associate professor of surgery at New York University School of Medicine in New York City, and one of the study’s senior authors.

“We saw [that] the only difference between those who had complete resolution of diabetes vs those who did not was their weight loss,” said Dr. Ren.

“It appears that in gastric banding, the probability of a patient having improvement or resolution of diabetes depends on how much weight you lose and keep off.” Evidence has been available on the efficacy of gastric bypass surgery on resolution of diabetes, but these results point to the efficacy of laparoscopic adjustable gastric banding in resolving diabetes and in controlling metabolic parameters in the morbidly obese patient with diabetes, said Alan Wittgrove, MD, FACS, a member of the executive council of the American Society of Metabolic and Bariatric Surgery and medical director of the Bariatric Surgical Program at Scripps Memorial Hospital in La Jolla, California.

“It’s important because the study follows the patients for at least 5 years,” said Dr. Wittgrove. “It shows the longevity of the procedure in resolving diabetes through weight loss and [its] impact on the metabolic syndrome.”

The study was independently conducted. Dr. Ren is a member of the Speaker’s Bureau, sits on an advisory board, and receives research and educational grants from Allergan Inc. She receives research and educational grants from Ethicon Endo-Surgery Inc and is a consultant for Explora Med Development, LLC. Dr. Wittgrove is a consultant for Ethicon Endo-Surgery Inc and receives research funding from Stryker Corporation.

American Society of Metabolic and Bariatric Surgery 2009 Annual Meeting: Abstract PL-104. Presented June 24, 2009.

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