TITLE

Bariatric Surgery Improves Glycemic Control

AUTHOR(S)
Pignone, Michael
PUB. DATE
June 2008
SOURCE
Clinical Diabetes;Summer2008, Vol. 26 Issue 3, p121
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Design. A randomized controlled trial comparing a conventional lifestyle change intervention to conventional management plus laparoscopic adjustable gastric banding for the outcomes of "diabetes regression," defined as fasting glucose < 126 mg/dl and hemoglobin A1c (A1C) < 6.2% while using no glucose-controlling medications. Subjects. Sixty patients with a BMI of 30-40 kg/m² and recently (within 2 years) diagnosed diabetes. Methods. Eligible participants were 20-60 years of age, had type 2 diabetes diagnosed within 2 years, and had no evidence of impaired renal function or diabetic retinopathy. Potential participants completed a 3-month run-in period that included efforts to optimize their diabetes treatment. Those completing the run-in period were randomized, and no attempt was made to blind patients or providers to their intervention status. Those assigned to conventional therapy had access to a team of providers and were seen at least every 6 weeks. They were counseled to follow a low-fat, low-glycemic-index diet and to engage in moderate physical activity. Those in the intervention group received similar conventional treatment, underwent laparoscopic placement of the adjustable gastric band, and had visits every 4-6 weeks. The main outcome of regression of diabetes was assessed after 2 years; secondary measures included A1C, weight, and lipid levels. Results. Of the 60 enrolled patients, 55 completed 2-year follow-up. Participants in the surgical intervention group were more likely to achieve diabetes remission than those in the conventional treatment control arm (73 vs. 13%, relative risk 5.5, 95% CI 2.2, 14.0). Weight loss was also greater in the surgical group (20.7 vs. 1.7% for the conventional treatment group). Remission was well correlated with weight loss (R² = 0.46). Four patients in the surgical arm had important adverse events (one post-surgical wound infection treated with intravenous antibiotics; two cases of gastric pouch enlargement requiring re-operation; and one patient who had "persistent eating difficulties" and required band removal). Conclusions. Obese adults with recent onset of diabetes who were assigned to receive laparoscopic gastric banding plus conventional therapy were more likely to achieve diabetes remission than those assigned to conventional treatment alone.
ACCESSION #
34063020

 

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