Laparoscopic gastric banding prevents type 2 diabetes and arterial hypertension and induces their remission in morbid obesity: a 4-year case-controlled study.
OBJECTIVE
Lifestyle modifications and pharmacological interventions can prevent type 2 diabetes in obese subjects with impaired glucose tolerance. The aim of this study was to compare laparoscopic adjustable gastric banding (LAGB) and conventional diet (No-LAGB) in the prevention (primary intervention study; 56 vs. 29 patients) and remission (secondary intervention study; 17 vs. 20 patients) of type 2 diabetes and hypertension in grade 3 obesity in a 4-year study.


METHODS
The subjects (n = 122; age 48.5 +/- 1.05 years; BMI 45.7 +/- 0.67 kg/m2) underwent a diagnostic workup, including psychological and psychiatric assessments, in preparation for the LAGB procedure. Of the 122 subjects, 73 had the surgery (LAGB group). The control group (No-LAGB group) consisted of the 49 subjects who refused the surgery but agreed to be followed up; 6 of these subjects dropped out by the 2nd year of the study, so that the final number of patients was 73 and 43 in the LAGB and No-LAGB groups, respectively. All patients had a yearly visit and oral glucose tolerance test.


RESULTS
From baseline to the end of the 4-year follow-up, BMI decreased from 45.9 +/- 0.89 at baseline to 37.7 +/- 0.71 kg/m2 in the LAGB group and remained steady in the No-LAGB group (from 45.2 +/- 1.04 to 46.5 +/- 1.37 kg/m2), with no significant differences between the primary and secondary intervention groups. In the primary intervention study, five of the No-LAGB subjects (17.2%) and none of the LAGB subjects (0.0%; P = 0.0001) progressed to type 2 diabetes; in the secondary intervention study, type 2 diabetes remitted in one No-LAGB patient (4.0%) and seven LAGB patients (45.0%; P = 0.0052). Hypertension occurred in 11 No-LAGB patients (25.6%) and 1 LAGB patient (1.4%; P = 0.0001) and remitted in 1 No-LAGB (2.3%) and 15 LAGB patients (20.5%; P = 0.0001). A study of body mass composition revealed a significant reduction of fat mass and a transitory, but not significant, decrease of fat-free mass in LAGB patients.


CONCLUSIONS
In morbid obesity, sustained and long-lasting weight loss obtained through LAGB prevents the occurrence of type 2 diabetes and hypertension and decreases the prevalence of these disorders.
Pontiroli
Antonio E
AE
Dipartimento di Medicina, Chirurgia e Odontoiatria, Università Degli Studi di Milano, Cattedra di Medicina Interna, Ospedale San Paolo, via a di Rudini, 8, 20142 Milano, Italy. antonio.pontiroli@unimi.it
Folli
Franco
F
Paganelli
Michele
M
Micheletto
Giancarlo
G
Pizzocri
Pierluigi
P
Vedani
Paola
P
Luisi
Francesca
F
Perego
Lucia
L
Morabito
Alberto
A
Bressani Doldi
Santo
S
D000328:Adult; D015992:Body Mass Index; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D015391:Gastroplasty / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control*; D007558:Italy / Q000453:epidemiology; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000175:diagnosis / Q000378:metabolism* / Q000601:surgery*; D015995:Prevalence; D013997:Time Factors; D016896:Treatment Outcome; D015431:Weight Loss