Adjustable gastric band feasible for treatment of type 2 diabetes, obesity


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

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

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Gastric banding led to improvements in HDL, particle size after 5 years.


Bariatric surgery using gastric banding did not improve LDL cholesterol or LDL particle number or size, despite significant weight loss among patients who underwent the procedure. Results suggest, however, a beneficial HDL remodeling process based on a significant increase in HDL cholesterol and HDL particle size.

Researchers from the New York University Langone Medical Center said the HDL remodeling process persisted up to 5 years after gastric banding.

“Knowing that some studies suggest early improvements in lipids after bariatric surgery, there is a paucity of data regarding changes in the lipoprotein abnormalities characteristic of the dyslipidemia of obesity. What we sought to do was to determine both initial and long-term effects of gastric banding surgery on lipids, with attention to LDL and HDL characteristics,” researcherAmita Singh, MD, from NYU Langone Medical Center in New York, said during a presentation here.

Patients with a BMI of 30 to 40 (n=50) underwent laparoscopic gastric banding. Physical exams and blood samples for nuclear magnetic resonance spectroscopy were performed at baseline and at annual follow-up, which lasted 5 years.

At 1 and 5 years, researchers observed significant increases in HDL cholesterol (P<.001). After 5 years, mean HDL size was significantly increased (9.1 nm at baseline vs. 9.24 nm at 5 years; P<.002), and there was a trend toward increased HDL particle number (33.49 nm/L at baseline vs. 36.75 nm/L; P=.064). Conversely, early reductions in LDL particle number and size were nonsignificant after 5 years.

Metabolic syndrome and percent BMI loss had no effect on changes in particle number or size for both LDL and HDL. However, LDL particle number and LDL cholesterol were significantly correlated at 5 years (P<.001), although HDL cholesterol and HDL particle number were not, the researchers wrote. – by Samantha Costa

  • This study was interesting in the fact that we didn’t see a lot of the changes we expected. Acute weight loss lowers your cholesterol, but losing weight doesn’t lower your cholesterol, and it’s often just dietary changes. It’s interesting to see that, but it’s also limited.
  • Donna M. Polk, MD, MPH
  • Physician at Hartford Hospital (Connecticut)

 

  • Source: Endocrine Today.