Laparoscopic adjustable gastric banding and progression from impaired fasting glucose to diabetes

• Published in: Diabetologia 2014-03, Vol.57 (3), p.463-468
• Main Authors: Wentworth, John M., Hensman, Tamishta, Playfair, Julie, Laurie, Cheryl, Ritchie, Matthew E., Brown, Wendy A., Skinner, Stewart, Shaw, Jonathan E., O’Brien, Paul E.
• Format: Article
• Language: English
• Subjects: Adult; Australia; Biological and medical sciences; Biomarkers - blood; Blood Glucose - metabolism; Cohort analysis; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - prevention & control; Diabetes. Impaired glucose tolerance; Disease Progression; Drug therapy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fasting; Female; Gastrointestinal surgery; Gastroplasty - methods; Glucose; Glycated Hemoglobin A - metabolism; Human Physiology; Humans; Incidence; Internal Medicine; Laparoscopy; Male; Medical sciences; Medicine; Medicine & Public Health; Metabolic Diseases; Middle Aged; Obesity; Obesity, Morbid - blood; Obesity, Morbid - surgery; Prevention; Retrospective Studies; Risk Factors; Treatment Outcome; Weight control; Weight Loss
• ISSN: 0012-186X; 1432-0428
• DOI: 10.1007/s00125-013-3129-0

Aims/hypothesis Obesity and dysglycaemia are major risk factors for type 2 diabetes. We determined if obese people undergoing laparoscopic adjustable gastric banding (LAGB) had a reduced risk of progressing from impaired fasting glucose (IFG) to diabetes. Methods This was a retrospective cohort study of obese people with IFG who underwent LAGB. Weight and diabetes outcomes after a minimum follow-up period of 4 years (mean ± SD 6.1 ± 1.7 years) were compared with those of Australian adults with IFG from a population-based study (AusDiab). Results We identified 281 LAGB patients with baseline IFG. Their mean ± SD age and BMI were 46 ± 9 years and 46 ± 9 kg/m 2 , respectively. The diabetes incidence for patients in the lowest, middle and highest weight loss tertile were 19.1, 3.4 and 1.8 cases/1,000 person-years, respectively. The AusDiab cohort had a lower BMI (28 ± 5 kg/m 2 ) and a diabetes incidence of 12.5 cases/1,000 person-years. This increased to 20.5 cases/1,000 person-years when analysis was restricted to the 322 obese AusDiab participants, which was higher than the overall rate of 8.2 cases/1,000 person-years seen in the LAGB group ( p  = 0.02). Multivariable analysis of the combined LAGB and AusDiab data suggested that LAGB was associated with ∼75% lower risk of diabetes (OR 0.24 [95% CI 0.10, 0.57], p  = 0.004). Conclusions/interpretation In obese people with IFG, weight loss after LAGB is associated with a substantially reduced risk of progressing to diabetes over ≥4 years. Bariatric surgery may be an effective diabetes prevention strategy in this population.