Patients with type 2 diabetes and obesity achieved similar 1-year benefits on diabetes control, cardiometabolic risk and patient satisfaction when undergoing laparoscopic adjustable gastric band or an intensive diabetes medical and weight management program, according to recent research.
Allison B. Goldfine, MD, head of Joslin Diabetes Center section of clinical research and associate professor of medicine at Harvard Medical School, and colleagues conducted a 12-month prospective, randomized clinical trial to evaluate the effects of laparoscopic adjustable gastric band (LAGB; n=18) and an intensive diabetes medical and weight management program (IMWM; n = 22). Participants were aged 21 to 65 years, had a BMI of 30 to 45 kg/m2, a diagnosis of type 2 diabetes more than 1 year before the study period and HbA1c of 6.5% or more on anti-hyperglycemic medications.
Allison B. Goldfine
A similar proportion of participants in the LAGB group achieved HbA1c less than 6.5% and fasting plasma glucose level below 7 mmol/L (33%) at 12 months compared with the IMWM group (23%; P = .457). The LAGB group revealed greater weight loss over 12 months (-13.5 kg) compared with the IMWM group (-8.5 kg). However, changes in fat free mass (P = .617) and decreases in waist circumference (P = .856) were similar between the groups.
Over the 12-month period, reductions in HbA1c were similar between the groups at -1.23% for the LAGB group and -0.95% for the IMWM group. The groups also had similar reductions in fasting glucose (P = .975).
The IMWM group had greater reductions in systolic blood pressure from baseline compared with the LAGB group (P = .038). However, no difference was found for change in diastolic BP, total cholesterol, triglycerides, HDL-cholesterol or LDL-cholesterol at 12 months. More participants in the LAGB group achieved LDL-cholesterol levels below 2.59 mmol/L following LAGB (83%) compared with the IMWM group (45%; P = .019).
Researchers used the United Kingdom Prospective Diabetes Study risk engine to determine changes in cardiometabolic risk scores for coronary heart disease, fatal CHD, stroke and fatal stroke, and the scores were similar between the groups 12 months following LAGB and IMWM.
“We can anticipate long-term health benefits from both of these approaches, but they do require different investment of time and energy by the patient and over the short-term our studies show metabolic outcomes are similar in patients comparable to those in our study,” Goldfine told Endocrine Today. “It is important to have different therapeutic options available for patients with a complex disease like type 2 diabetes.” – by Amber Cox