Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial.
BACKGROUND
Observational studies suggest that surgically induced loss of weight may be effective therapy for type 2 diabetes.


OBJECTIVE
To determine if surgically induced weight loss results in better glycemic control and less need for diabetes medications than conventional approaches to weight loss and diabetes control.


METHODS
Unblinded randomized controlled trial conducted from December 2002 through December 2006 at the University Obesity Research Center in Australia, with general community recruitment to established treatment programs. Participants were 60 obese patients (BMI >30 and <40) with recently diagnosed (<2 years) type 2 diabetes.


METHODS
Conventional diabetes therapy with a focus on weight loss by lifestyle change vs laparoscopic adjustable gastric banding with conventional diabetes care.


METHODS
Remission of type 2 diabetes (fasting glucose level <126 mg/dL [7.0 mmol/L] and glycated hemoglobin [HbA1c] value <6.2% while taking no glycemic therapy). Secondary measures included weight and components of the metabolic syndrome. Analysis was by intention-to-treat.


RESULTS
Of the 60 patients enrolled, 55 (92%) completed the 2-year follow-up. Remission of type 2 diabetes was achieved by 22 (73%) in the surgical group and 4 (13%) in the conventional-therapy group. Relative risk of remission for the surgical group was 5.5 (95% confidence interval, 2.2-14.0). Surgical and conventional-therapy groups lost a mean (SD) of 20.7% (8.6%) and 1.7% (5.2%) of weight, respectively, at 2 years (P < .001). Remission of type 2 diabetes was related to weight loss (R2 = 0.46, P < .001) and lower baseline HbA1c levels (combined R2 = 0.52, P < .001). There were no serious complications in either group.


CONCLUSIONS
Participants randomized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss. These results need to be confirmed in a larger, more diverse population and have long-term efficacy assessed.


BACKGROUND
actr.org Identifier: ACTRN012605000159651.
Dixon
John B
JB
Centre for Obesity Research and Education, Monash University Medical School, The Alfred Hospital, Melbourne, Victoria, Australia. john.dixon@med.monash.edu.au
O'Brien
Paul E
PE
Playfair
Julie
J
Chapman
Leon
L
Schachter
Linda M
LM
Skinner
Stewart
S
Proietto
Joseph
J
Bailey
Michael
M
Anderson
Margaret
M
D000328:Adult; D001786:Blood Glucose; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy*; D015444:Exercise; D005260:Female; D015391:Gastroplasty; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000601:surgery*; D012074:Remission Induction; D040242:Risk Reduction Behavior; D015431:Weight Loss
D001786:Blood Glucose