title: Long-term metabolic outcome and quality of life after laparoscopic adjustable gastric banding in obese patients with type 2 diabetes mellitus or impaired fasting glucose.
abstract: BACKGROUND
  The long-term outcome of type 2 diabetes mellitus after laparoscopic adjustable gastric banding (LAGB) is unknown.
  
  
  METHODS
  A longitudinal cohort study was undertaken of patients with grade 3 obesity and type 2 diabetes or impaired fasting glucose (IFG) undergoing LAGB. Metabolic outcomes and quality of life (QoL) were assessed before and 5 years after LAGB.
  
  
  RESULTS
  At 5 years, data for 22 out of 23 patients with type 2 diabetes and 51 out of 53 with IFG were available. Mean(s.d.) excess weight loss was 41(25) and 41(27) per cent in patients with type 2 diabetes and IFG respectively, and was associated with a significant decrease in haemoglobin (Hb) A1c, fasting and postprandial blood glucose, insulin and triglyceride levels, and in liver steatosis. There were significant increases in insulin sensitivity, beta-cell function, disposition index, high-density lipoprotein-cholesterol and QoL (Nottingham Health Profile). Good metabolic control (HbA1c 7 per cent or less) was obtained in 13 diabetic patients, but complete diabetes remission was maintained in only four. Longer duration of diabetes, and poor preoperative glucose control and beta-cell function at baseline were associated with a less favourable outcome.
  
  
  CONCLUSIONS
  LAGB improved metabolic outcomes and QoL in patients with grade 3 obesity with IFG or type 2 diabetes but rarely led to prolonged remission in long-standing diabetes.
authors.affiliation: U859 Biotherapies for Diabetes, Institut National de la Santé et de la Recherche Médicale/Université Lille-Nord de France.
authors.forename: R
authors.initials: R
authors.lastname: Caiazzo
authors.forename: L
authors.initials: L
authors.lastname: Arnalsteen
authors.forename: M
authors.initials: M
authors.lastname: Pigeyre
authors.forename: G
authors.initials: G
authors.lastname: Dezfoulian
authors.forename: H
authors.initials: H
authors.lastname: Verkindt
authors.forename: J
authors.initials: J
authors.lastname: Kirkby-Bott
authors.forename: P
authors.initials: P
authors.lastname: Mathurin
authors.forename: P
authors.initials: P
authors.lastname: Fontaine
authors.forename: M
authors.initials: M
authors.lastname: Romon
authors.forename: F
authors.initials: F
authors.lastname: Pattou
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods; D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000378:metabolism; D005215:Fasting / Q000097:blood; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008134:Long-Term Care; D008137:Longitudinal Studies; D008297:Male; D009767:Obesity, Morbid / Q000601:surgery*; D011788:Quality of Life; D015431:Weight Loss
chemical_list: D001786:Blood Glucose