Early surgical intervention with gastric banding in obese patients with type 2 diabetes should be considered an effective treatment option, according to Ted Okerson, MD, et al, from the University of California at Irvine.1 While weight loss can significantly improve glycemic control, and “lifestyle changes are the foundation to the treatment of type 2 diabetes, it is difficult to achieve and sustain [that weight loss],” said Dr. Okerson.1
In an evaluation of 47 patients with type 2 diabetes participating in the LAP-BAND AP Experience (APEX) trial—an ongoing, 5-year, prospective, multi-center, open-label, observational study—who underwent laparoscopic adjustable gastric banding and completed their 2-year postoperative visit, remission and improvement were achieved by 48.5% (n = 23) and 47% (n = 24), respectively. No change was experienced in 4.5% of patients (n = 3). “Remission” was defined as elimination of hypoglycemic medication and “improvement” was defined as reduction in hypoglycemic medication. Patients experiencing remission or improvement had an average type 2 diabetes duration of 4.0 and 6.7 years, respectively.
Excess weight loss was an interesting aspect of the study. “Excess weight was defined as how much weight a patient needed to lose to get to a [body mass index] of 25,” said Dr. Okerson. At 2 years, the percent excess weight loss was significantly greater in patients with remission (-55.7%) versus those patients with improvement (42.9%) (p = 0.03). Excess weight loss also only marginally correlated with a change is type 2 diabetes status.1
Additionally, patients in the APEX trial saw improvements in obesity-related comorbidities including 90.8% in hypertension, 76.9% in hyperlipidemia, 86% in obstructive sleep apnea, 91% in gastroesophageal reflux disease, 92.7% in osteoarthritis, and 75.4% in depression.
Investigators concluded that gastric banding is an established surgical option for obese patients with type 2 diabetes, and when used as an early intervention, is beneficial for remission of type 2 diabetes.