Gastric Band Surgery and Intensive Medical Program Yield Similar Benefits on T2D

Laparoscopic adjustable band (LAGB) surgery and an intensive medical diabetes and weight management (IMWM) program have similar one-year benefits on diabetes control, cardiometabolic risk, and patient satisfaction, according to a study recently published in the Journal of Clinical Endocrinology & Metabolism.

Researchers led by Allison B. Goldfine, MD, of the Joslin Diabetes Center at Harvard Medical School, noted that surgical recommendations, as opposed to lifestyle changes and pharmacological interventions, for treating type 2 diabetes (T2D) remain controversial. So Goldfine and her team set out to compare the two approaches.

In a 12-month, randomized clinical trial the researchers compared 23 people undergoing LAGB surgery to 22 people participating in an IMWM program. The subjects were “aged 21– 65 years with body mass index of 30 – 45 kg/m2 , T2D diagnosed more than 1 year earlier, and glycated hemoglobin (HbA1c) 6.5% on antihyperglycemic medication(s).” After randomization, five participants did not undergo surgery. “Seven of the 18 LAGB and eight of the 22 IMWM participants had BMI below 35 kg/m2,” the authors write. “Of those that initiated intervention, three missed 12-month assessments due to time constraints, and one moved out of state. Twelve-month retention rates were 94% in the LAGB group and 82% in the IMWM group.”

The proportion of patients who met the primary glycemic endpoint (HbA1c 6.5% and fasting glucose 7.0 mmol/L at 12 months, on or off medication) was 33% in the LAGB group and 23% in the IMWM group. HbA1c reduction was similar in both groups and three and 12 months, and weight loss was similar in both groups at three months but greater in the LAGB group at 12 months. “Systolic blood pressure reduction was greater after IMWM than LAGB, whereas changes in diastolic blood pressure, lipids, fitness, and cardiovascular risk scores were similar between groups,” the researchers write. “Patient-reported health status, assessed using the Short Form-36, Impact of Weight on Quality of Life, and Problem Areas in Diabetes, all improved similarly between groups.”

Goldfine and her team conclude that these findings point to LAGB and IMWM having similar beneficial outcomes on diabetes control, cardiometabolic risk, and quality of life over one year. “These results may be useful in guiding obese patients with T2D when they explore their options for glycemic and weight management, but it will be important to assess the durability of health benefits from these approaches as differences may emerge over time,” they write.

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