Metabolic outcomes of obese diabetic patients following laparoscopic adjustable gastric banding.
BACKGROUND
Obesity is an independent risk factor in the development of diabetes. Weight loss surgery is the most effective treatment of morbid obesity. This study examines the effect of gastric banding on metabolic profile in diabetics.


METHODS
Between April 2003 and November 2007, 1,335 patients underwent laparoscopic adjustable gastric banding. Metabolic profile was examined on a subset of 254 patients. Of these, 122 were diabetic. Data collection included body mass index, weight, blood pressure, HbA1c, fasting glucose, total serum cholesterol, triglyceride, and medications taken for blood pressure and diabetes both preoperatively and 1 year postoperatively.


RESULTS
Comorbid conditions in the diabetic patients included hypercholesterolemia (49.3%), hypertriglyceridemia (53.8%) and hypertension (92%). In 1 year, mean BMI reduced from 52.9 kg/m(2) to 41.5 kg/m(2). Of the patients, 93.1% experienced an improvement in fasting glucose levels and 75.4% patients an improvement in HbA1c levels at the end of 1 year. All patients experienced a decrease in insulin requirements, and 36.6% were able to totally discontinue using it. Of the patients, 100% showed improvement in their triglyceride level, and 90.9% showed improvement in their total cholesterol level. The mean arterial pressure improved in 87.5% of the patients.


CONCLUSIONS
The metabolic syndrome associated with morbid obesity is difficult to adequately control with medication. Laparoscopic gastric banding can be considered a potentially curative treatment option in the management of this syndrome.
Singhal
Rishi
R
Upper GI Unit and Minimally Invasive Unit, Heart of England NHS Foundation Trust, Birmingham, UK. singhal_rishi@rediffmail.com
Kitchen
Mark
M
Bridgwater
Sue
S
Super
Paul
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000378:metabolism*; D005260:Female; D015391:Gastroplasty / Q000379:methods; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D010535:Laparoscopy; D008297:Male; D024821:Metabolic Syndrome / Q000601:surgery; D008875:Middle Aged; D009767:Obesity, Morbid / Q000453:epidemiology / Q000378:metabolism* / Q000601:surgery; D055815:Young Adult