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Gastric banding vs. metformin

Gastric banding more effective than metformin in treating T2DM

Gastric banding more effective for weight loss than medication

People with prediabetes or new-onset type 2 diabetes who had gastric banding had similar stabilisation of their disease to those who took metformin alone, according to a study supported by the National Institutes of Health. These findings were presented at the European Association for the Study of Diabetes Annual Meeting in Berlin, and in the paper, ‘Impact of Gastric Banding Versus Metformin on β-Cell Function in Adults With Impaired Glucose Tolerance or Mild Type 2 Diabetes', published in Diabetes Care.

The Beta Cell Restoration through Fat Mitigation (BetaFat) study, enrolled 88 participants with mild to moderate obesity and either prediabetes or new-onset type 2 diabetes. Half of the participants were randomly assigned to receive a gastric banding procedure, the other participants received the drug metformin, the most common first-line medication for people with prediabetes and early type 2 diabetes. The BetaFat study was conducted at the University of Southern California, Los Angeles, in collaboration with Kaiser Permanente Southern California.

Hyperglycemic clamps (11.1mmol/L) followed by arginine injection at maximally potentiating glycaemia (>25mmol/L) were performed at baseline, 12 months, and 24 months to measure steady-state C-peptide (SSCP) and acute C-peptide response to argenine at maximum glycaemic potentiation (ACPRmax) and insulin sensitivity (M/I).

At 24 months, the band group lost 10.7kg and the the metformin group lost 1.7kg (p<0.01). Insulin sensitivity increased 45% in the band group and 25% in the metformin group (p=0.30 between groups). SSCP adjusted for insulin sensitivity fell slightly but not significantly in each group (p=0.34 between groups). ACPRmax adjusted for insulin sensitivity fell significantly in the metformin group (p=0.002) but not in the band group (p=0.25 between groups). HbA1c fell at 12 and 24 months in the band group (p<0.004) but only at 12 months (p<0.01) in the metformin group (p>0.14 between groups). Normoglycaemia was present in 22% and 15% of band and metformin groups, respectively, at 24 months (p=0.66 between groups).

These results are part of the Restoring Insulin Secretion (RISE) study, a set of three clinical trials designed to find ways to reverse or slow the loss of insulin production and release in people at risk for type 2 diabetes or recently diagnosed with the disease so that they can stay healthier longer. While BetaFat compared results from surgical weight loss to medication, the two other RISE trials examine the effects of a variety of medications in youth and adults.

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