Gastric banding effective against diabetes in the severely obese

By David Douglas

NEW YORK (Reuters Health) – Laparoscopic adjustable gastric banding led to complete remission of type 2 diabetes in most obese subjects who underwent the procedure, Australian researchers report in the February issue of Diabetes Care.

In fact, lead author Dr. John B. Dixon told Reuters Health that "this study indicates the importance of weight loss in the management of type 2 diabetes." The results, he added, "show that if weight loss is achieved early following a diagnosis of diabetes, the process is completely reversed."

Drs. Dixon and Paul E. O'Brien, of Alfred Hospital, Melbourne, conducted a prospective study of 50 selected patients with type 2 diabetes who were evaluated before and one year after surgery.

Preoperatively, mean weight was 137 kg and mean body mass index (BMI) was 48.2 kg/m². Postoperatively, mean weight fell to 110 kg and mean BMI to 38.7.

Early surgical complications were experienced by 6% of patients, and late complications, all of which were dealt with successfully, were encountered by 30%.

Diabetes remission was seen in 32 patients (64%), and there was a major improvement in glucose control in 13 (26%). There was no improvement in glucose control in the remaining 5 patients. Remission was associated with greater weight loss and a shorter history of diabetes.

The researchers, who note that patients also showed improvements in levels of HDL cholesterol, hypertension, mood, and health-related quality of life, conclude that "surgery should be considered as an early intervention," in such severely obese individuals.

In an accompanying editorial, Dr. John A. Tayek, of Harbor-UCLA Medical Center, Torrance, California, agrees that the procedure offers hope to the severely obese, but points out that "it must be tested prospectively in obese individuals before it can be recommended as a treatment for type 2 diabetes."

Diabetes Care 2002;25:358-363,397-398.

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