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Laparoscopic Gastric Banding Prevents Type 2 Diabetes and Arterial Hypertension and Induces Their Remission in Morbid Obesity

A 4-year case-controlled study

¹ Dipartimento di Medicina, Chirurgia e Odontoiatria, Università degli Studi di Milano, Milan, Italy
² Divisione di Medicina 2, Ospedale San Paolo, Milan, Italy
³ Divisione di Medicina, Ospedale San Raffaele, Milan, Italy
⁴ Divisione di Chirurgia, Ospedale San Raffaele, Milan, Italy
⁵ Dipartimento di Scienze Chirurgiche, Istituto Clinico Sant Ambrogio, Milan, Italy

Address correspondence and reprint requests to Antonio E. Pontiroli, MD, Università Degli Studi di Milano, Cattedra di Medicina Interna, Ospedale San Paolo, via a di Rudini, 8, 20142 Milano, Italy. E-mail: antonio.pontiroli{at}unimi.it

OBJECTIVE—Lifestyle modifications and pharmacological interventions can prevent type 2 diabetes in obese subjects with impaired glucose tolerance. The aim of this study was to compare laparoscopic adjustable gastric banding (LAGB) and conventional diet (No-LAGB) in the prevention (primary intervention study; 56 vs. 29 patients) and remission (secondary intervention study; 17 vs. 20 patients) of type 2 diabetes and hypertension in grade 3 obesity in a 4-year study.

RESEARCH DESIGN AND METHODS—The subjects (n = 122; age 48.5 ± 1.05 years; BMI 45.7 ± 0.67 kg/m²) underwent a diagnostic workup, including psychological and psychiatric assessments, in preparation for the LAGB procedure. Of the 122 subjects, 73 had the surgery (LAGB group). The control group (No-LAGB group) consisted of the 49 subjects who refused the surgery but agreed to be followed up; 6 of these subjects dropped out by the 2nd year of the study, so that the final number of patients was 73 and 43 in the LAGB and No-LAGB groups, respectively. All patients had a yearly visit and oral glucose tolerance test.

RESULTS—From baseline to the end of the 4-year follow-up, BMI decreased from 45.9 ± 0.89 at baseline to 37.7 ± 0.71 kg/m² in the LAGB group and remained steady in the No-LAGB group (from 45.2 ± 1.04 to 46.5 ± 1.37 kg/m²), with no significant differences between the primary and secondary intervention groups. In the primary intervention study, five of the No-LAGB subjects (17.2%) and none of the LAGB subjects (0.0%; P = 0.0001) progressed to type 2 diabetes; in the secondary intervention study, type 2 diabetes remitted in one No-LAGB patient (4.0%) and seven LAGB patients (45.0%; P = 0.0052). Hypertension occurred in 11 No-LAGB patients (25.6%) and 1 LAGB patient (1.4%; P = 0.0001) and remitted in 1 No-LAGB (2.3%) and 15 LAGB patients (20.5%; P = 0.0001). A study of body mass composition revealed a significant reduction of fat mass and a transitory, but not significant, decrease of fat-free mass in LAGB patients.

CONCLUSIONS—In morbid obesity, sustained and long-lasting weight loss obtained through LAGB prevents the occurrence of type 2 diabetes and hypertension and decreases the prevalence of these disorders.

Abbreviations: BPD, biliary pancreatic diversion • GBP, gastric bypass • IGT, impaired glucose tolerance • LAGB, laparoscopic adjustable gastric banding • NGT, normal glucose tolerance • OGTT, oral glucose tolerance test • SOS, Swedish Obese Subjects

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The Effects of Laparoscopic Gastric Banding, a Weight Loss Surgery

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