Health outcomes of severely obese type 2 diabetic subjects 1 year after laparoscopic adjustable gastric banding.
OBJECTIVE
To prospectively examine the effect of weight loss 1 year after laparoscopic adjustable gastric band surgery on a broad range of health outcomes in 50 diabetic subjects.


METHODS
A total of 50 (17 men, 33 women) of 51 patients with type 2 diabetes, from a total of 500 consecutive patients, were studied preoperatively and again 1 year after surgery.


RESULTS
Preoperative weight and BMI (means +/- SD) were 137 +/- 30 kg and 48.2 +/- 8 kg/m(2), respectively; at 1 year, weight and BMI were 110 +/- 24 kg and 38.7 +/- 6 kg/m(2), respectively. There was significant improvement in all measures of glucose metabolism. Remission of diabetes occurred in 32 patients (64%), and major improvement of glucose control occurred in 13 patients (26%); glucose metabolism was unchanged in 5 patients (10%). HbA(1c) was 7.8 +/- 3.2% preoperatively and 6.2 +/- 2.7% at 1 year (P < 0.001). Remission of diabetes was predicted by greater weight loss and a shorter history of diabetes (pseudo r(2) = 0.44, P < 0.001). Improvement in diabetes was related to increased insulin sensitivity and beta-cell function. Weight loss was associated with significant improvements in fasting triglyceride level, HDL cholesterol level, hypertension, sleep, depression, appearance evaluation, and health-related quality of life. Early complications occurred in 6% of patients (wound infections in 4%, respiratory support in 2%), and late complications occurred in 30% of patients (gastric prolapse in 20%, band erosion in 6%, and tubing leaks in 4%). All late complications were successfully revised surgically.


CONCLUSIONS
Modern laparoscopic weight-loss surgery is effective in managing the broad range of health problems experienced by severely obese individuals with type 2 diabetes. Surgery should be considered as an early intervention.
Dixon
John B
JB
Department of Surgery, Monash University, Alfred Hospital, Melbourne 3181, Victoria, Australia. john.dixon@med.monash.edu.au
O'Brien
Paul E
PE
D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D003863:Depression / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D015391:Gastroplasty; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D007328:Insulin / Q000378:metabolism; D007515:Islets of Langerhans / Q000378:metabolism; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000150:complications* / Q000523:psychology / Q000601:surgery*; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000150:complications; D016896:Treatment Outcome; D015431:Weight Loss; D005723:gamma-Glutamyltransferase / Q000097:blood
D001786:Blood Glucose; D007328:Insulin; D002784:Cholesterol; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase