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Tuesday, January 22, 2008

Tightening the Band on Diabetes

A study published in today's JAMA, found that obese patients with Type 2 diabetes who underwent laparoscopic adjustable gastric banding (LAGB) were five times more likely to have their diabetes go into remission than patients who engaged in conventional weight loss therapies, such as diet and exercise.

The four-year study, which was led by Drs. John Dixon and Paul O’Brien from Monash University’s Centre for Obesity Research and Education (CORE), monitored 60 volunteers for two years who underwent significant weight loss of more than 10 per cent of their body weight.

Of those who underwent gastric banding surgery, 73% achieved remission for Type 2 diabetes, compared to just 13% of the people who underwent conventional therapy. This was largely attributable to the far greater weight loss in the band patients, who lost on average 20% of their initial body weight.

What is remarkable about this study is not that bariatric surgery leads to remission of diabetes - this we've known for a while.

What is new, however, is the fact that the subjects in this study had a BMI in the 30-40 range, i.e. a range not normally considered for bariatric sugery (for e.g. the average BMI in the Adult WW Clinic is 57!).

Of course, there were the expected complications with the LABG, including one band removal. Nevertheless, the point is that a relatively simple surgical procedure (which can essentially be performed in under 60 minutes as day surgery in experienced centres) can "cure" a condition for which the alternative is lifelong medical treatment.

Should surgeons now rush in and operate on all patients with type 2 diabetes?

Certainly not (yet?).

Despite the ease of the actual surgical procedure, patient management remains complex. Not only do patients have to make significant (lifelong) changes in their diet and eating pattern, but the need for regular band adjustments also make regular follow-ups by physicians familiar in dealing with these patients mandatory.

My guess is that all of the usual caveats to bariatric surgery will apply to this population including on-going addictions, mental health problems, binge eating disorders, non-compliance, etc.

But for selected patients with recently-diagnosed type 2 diabetes at experienced centres, probably the way to go.

Perhaps time for some diabetologists to start honing their band management skills?


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