Raj Padwal, MD
Does laparoscopic adjustable gastric banding (LAGB) improve glycemic control more than conventional therapy (CT) alone in obese patients with recently diagnosed type 2 diabetes?
Randomized controlled trial.
Obesity research center in Melbourne, Victoria, Australia.
60 patients 20 to 60 years of age (mean age 47 y, 53% women) who had a body mass index of 30 to 40, diagnosis of type 2 diabetes in the past 2 years, and no renal impairment or diabetic retinopathy. Exclusion criteria included type 1 diabetes, diabetes secondary to specific disease, previous bariatric surgery, and medical problems (e.g., mental impairment, addiction, recent major vascular events, internal malignancy, or portal hypertension).
LAGB plus CT (n = 30) or CT alone (n = 30). CT comprised access to a general physician, dietitian, nurse, and diabetes educator; visits with ≥ 1 team member every 6 weeks; individualized medical therapies determined by a diabetologist; individually tailored lifestyle modification programs (reduced energy and fat intake and increased intake of high-fiber, low-glycemic-index foods; and physical activity advice).
Included diabetes remission (fasting plasma glucose levels < 126 mg/dL [6.993 mmol/L] and HbA1c levels < 6.2% without use of oral hypoglycemics or insulin) and weight change.
92% completed follow-up (100% in intention-to-treat analysis).
At 2 years, more patients in the LAGB group achieved diabetes remission than in the CT alone group (Table). The LAGB group lost more weight than the CT alone group (difference between groups −19.6 kg, 95% CI −23.8 to −15.2). Greater percentage of weight loss at 2 years and lower baseline HbA1c levels were independently associated with remission (P <0.001).
Laparoscopic adjustable gastric banding improved glycemic control more than conventional therapy alone in obese patients with recently diagnosed type 2 diabetes.
Laparoscopic adjustable gastric banding (LAGB) plus conventional therapy (CT) vs CT alone for recently diagnosed type 2 diabetes in obese patients‡
‡Abbreviations defined in Glossary. RBI, NNT, and CI calculated from data in article.
§Fasting plasma glucose levels < 126 mg/dL (6.993 mmol/L) and HbA1c < 6.2% without use of hypoglycemics or insulin.
Padwal R. Adjustable gastric banding improved glycemic control in obese patients with type 2 diabetes. Ann Intern Med. ;149:JC1–3. doi: 10.7326/0003-4819-149-2-200807150-02003
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Published: Ann Intern Med. 2008;149(2):JC1-3.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Obesity.
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