Laparoscopic adjustable gastric banding produced a 76% remission rate in the first randomized trial to compare the surgery against conventional treatment in obese patients with recent-onset type 2 diabetes.
“After 2 years, the surgical group displayed a 5 times higher remission rate and a 4 times greater reduction in [hemoglobin A1c] values than the conventional-therapy group,” according to John B. Dixon, Ph.D., of Monash University, Melbourne, and his associates.
The surgical group also showed greater resolution of features of the metabolic syndrome and greater improvements in insulin sensitivity, lipid profiles, and hypertension, allowing for significant reduction in their use of medications for these conditions as well as their use of drugs for glycemic control.
The investigators attributed the procedure's benefits principally to its great effectiveness in inducing weight loss, rather than to other antidiabetes effects, such as those reported with the Roux-en-Y gastric bypass procedure.
In the study, patients diagnosed as having type 2 diabetes within the preceding 2 years and with a body mass index of 30–40 were randomly assigned to receive conventional medical and behavioral therapy either alone (26 subjects) or in addition to laparoscopic adjustable gastric banding via the pars flaccida technique (29 subjects). All subjects met with at least one member of a treatment team every 6 weeks during the 2-year follow-up.
The mean surgical time was 54 minutes; 80% of patients were discharged after 1 day of hospitalization.
The surgery group achieved a mean weight loss of 20.7%, compared with 1.4% for the conventional therapy group. Complete remission of diabetes occurred in 76% of the surgery group, compared with 15% of the controls, the authors said (JAMA 2008:299:316–23).
There were no surgical complications. The rate of postoperative wound infection was under 2%. Reoperation to enlarge the gastric pouch was needed in 5% of subjects.
In an editorial comment, Dr. David E. Cummings and Dr. David R. Flum of the University of Washington, Seattle, said the results should lead providers and professional societies to reconsider the role of surgery in treating diabetes.
“It may be time to view bariatric operations not as treatments for patients with BMI greater than a certain level, but rather as interventions about which all obese patients with diabetes should be informed and [to which they should be] given access,” they said (JAMA 2008;299:341–3).
EMILY BRANNAN, ILLUSTRATION