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© 2002 by the American Diabetes Association, Inc.
Emerging Treatments and Technologies |
Health Outcomes of Severely Obese Type 2 Diabetic Subjects 1 Year After Laparoscopic Adjustable Gastric Banding
1 From the Monash University Department of Surgery, Alfred Hospital, Melbourne, Victoria, Australia
OBJECTIVE—To prospectively examine the effect of weight loss 1 year after laparoscopic adjustable gastric band surgery on a broad range of health outcomes in 50 diabetic subjects.
RESEARCH DESIGN AND METHODS—A total of 50 (17 men, 33 women) of 51 patients with type 2 diabetes, from a total of 500 consecutive patients, were studied preoperatively and again 1 year after surgery.
RESULTS—Preoperative weight and BMI (means ± SD) were 137 ± 30 kg and 48.2 ± 8 kg/m2, respectively; at 1 year, weight and BMI were 110 ± 24 kg and 38.7 ± 6 kg/m2, respectively. There was significant improvement in all measures of glucose metabolism. Remission of diabetes occurred in 32 patients (64%), and major improvement of glucose control occurred in 13 patients (26%); glucose metabolism was unchanged in 5 patients (10%). HbA1c was 7.8 ± 3.2% preoperatively and 6.2 ± 2.7% at 1 year (P < 0.001). Remission of diabetes was predicted by greater weight loss and a shorter history of diabetes (pseudo r2 = 0.44, P < 0.001). Improvement in diabetes was related to increased insulin sensitivity and ß-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.
CONCLUSIONS—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.
Abbreviations: %EWL, percentage of excess weight loss • %EWL1, %EWL at 1 year • HOMA, homeostasis model assessment • HUMA%B, percentage of ß-islet cell function assessed by HOMA • HOMA%S, percentage of insulin sensitivy assessed by HOMA • LAGB, laparoscopically placed adjustable gastric band • pr2, pseudo r2
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