title: The Effect of Weight Loss on Indigenous Australians with Diabetes: a study of Feasibility, Acceptability and Effectiveness of Laparoscopic Adjustable Gastric Banding.
abstract: OBJECTIVE
  Diabetes and obesity are common and serious health challenges for indigenous people worldwide. The feasibility of achieving substantial weight loss, leading to remission of diabetes, was evaluated in a regional indigenous Australian community.
  
  
  METHODS
  A prospective cohort study of 30 obese indigenous adults from the Rumbalara Aboriginal Co-operative in Central Victoria was performed. Inclusion criteria included aboriginality, BMI > 30 kg/m(2) and diabetes diagnosed within the last 10 years. Weight loss was achieved using laparoscopic adjustable gastric banding (LAGB). Participants were treated in their community and followed for 2 years. Outcomes were compared with those of non-indigenous Australians from an earlier randomized controlled trial (RCT) using a similar protocol.
  
  
  RESULTS
  30 participants (26 females, mean age 44.6 years; mean BMI 44.3) had LAGB at the regional hospital. Twenty-six participants completed diabetes assessment at 2 years follow-up. They showed diabetes remission (fasting blood glucose < 7.0 mmol/L and haemoglobin A1c (HbA1c) < 6.2 % while off all therapy except metformin) in 20 of the 26 and a mean weight loss (SD) of 26.0 (14) kilograms. Based on intention-to-treat, remission rate was 66 %. Quality of life improved. There was one early event and 12 late adverse events. The outcomes for weight loss and diabetes remission were not different from the LAGB group of the RCT.
  
  
  CONCLUSIONS
  For obese indigenous people with diabetes, a regionalized model of care centred on the LAGB is an effective approach to a serious health problem. The model proved feasible and acceptable to the indigenous people.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry (ACTRN 12609000319279).
authors.affiliation: Centre for Obesity Research and Education, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, VIC, Australia. paul.obrien@monash.edu.
authors.forename: Paul E
authors.initials: PE
authors.lastname: O'Brien
authors.affiliation: School of Rural Health, The University of Melbourne, Shepparton, VIC, Australia.|Rumbalara Aboriginal Co-operative Pty. Ltd, Mooropna, VIC, Australia.
authors.forename: Dawn E
authors.initials: DE
authors.lastname: DeWitt
authors.affiliation: Centre for Obesity Research and Education, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, VIC, Australia.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Laurie
authors.affiliation: Centre for Obesity Research and Education, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, VIC, Australia.|School of Psychology, Australian Catholic University, Melbourne, Australia.
authors.forename: Leah
authors.initials: L
authors.lastname: Brennan
authors.affiliation: Centre for Obesity Research and Education, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, VIC, Australia.
authors.forename: John M
authors.initials: JM
authors.lastname: Wentworth
authors.affiliation: Centre for Obesity Research and Education, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, VIC, Australia.
authors.forename: Margaret
authors.initials: M
authors.lastname: Anderson
authors.affiliation: School of Population Health, University of South Australia, Adelaide, SA, Australia.
authors.forename: Kerin
authors.initials: K
authors.lastname: O'Dea
authors.affiliation: Rumbalara Aboriginal Co-operative Pty. Ltd, Mooropna, VIC, Australia.
authors.forename: Felicia
authors.initials: F
authors.lastname: Dean
authors.affiliation: Centre for Obesity Research and Education, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, 3004, VIC, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Smith
authors.affiliation: School of Rural Health, The University of Melbourne, Shepparton, VIC, Australia.
authors.forename: David P
authors.initials: DP
authors.lastname: Dalton
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000208:ethnology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D015391:Gastroplasty / Q000379:methods*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000208:ethnology / Q000503:physiopathology / Q000601:surgery*; D010342:Patient Acceptance of Health Care / Q000208:ethnology; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D015431:Weight Loss
chemical_list: D006442:Glycated Hemoglobin
keywords: Aboriginal; Bariatric surgery; Gastric banding; Indigenous; LAGB; Obesity; Remission of diabetes; Type 2 diabetes; Weight loss