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Study finds LAGB can be used to prevent diabetes
Weight loss could be crucial in preventing patients with impaired fasting glucose (IGF) developing diabetes, according to a study published in Diabetologia. The authors from the Centre for Obesity Research and Education (CORE), Monash University,the Walter and Eliza Hall Institute, University of Melbourne, and the Baker IDI Heart and Diabetes Institute, Australia, report that patients who received a laparoscopic adjustable gastric band (LAGB) had a reduced risk of progressing from IFG to diabetes.
“We show that the rate of progression from IFG to diabetes is substantially reduced in obese people who undergo LAGB surgery…these findings strengthen the case for a randomised trial to determine whether LAGB surgery is a safe and cost-effective approach to preventing type 2 diabetes in this population.”
The investigators note that patients with IFG are at high risk of developing type 2 diabetes and obesity is a major risk factor. Therefore, they assessed whether LAGB in obese patients with IFG reduced the risk of developing type 2 diabetes.
This retrospective cohort study looked at the outcomes of obese people with IFG who underwent LAGB and compared them with those of Australian adults with IFG from a population-based study (AusDiab).
A total of 3,174 patients underwent LAGB between October 1995 and August 2007, 333 (248 women and 85 men) had IFG (5.6–6.9mmol/l) and no history of diabetes or of glucose-lowering drug use. Of the 333 patients, 281 (84%; 210 women and 71 men) had follow-up weight and FPG data.
At five years, the LAGB patients lost an average of 25kg. After a minimum follow-up period of four years, 14 patients developed diabetes (12 women) and 169 did not. There was a strong relationship between the weight change and the occurrence of diabetes.
When they compared these results with those of 1,043 AusDiab patients who had IFG and were followed for five years, 65 AusDiab participants developed diabetes. Importantly, when they examined obese AusDiab patients, the incidence of diabetes increased significantly (p<0.001) and was greater than the LAGB group (p<0.02).
To assess whether banding was independently associated with diabetes, they combined the data from both groups, replacing percentage weight change with the presence or absence of LAGB surgery. They found that from 1,324 patients, LAGB was associated with a reduced risk of diabetes of more than 75% (OR 0.239 [95% CI 0.095, 0.571], p =0.004), with female sex and baseline FPG also significantly associated with progression to diabetes.
“Taken together with the findings of the multivariable analysis, we conclude that weight loss in obesity complicated by IFG prevents progression to diabetes,” the authors write. “This accords with the recent Swedish Obese Subjects findings, trials of weight loss drugs and other reports of remission of diabetes after medical or surgically induced weight loss.”