The Effect of Weight Loss on Indigenous Australians with Diabetes: a study of Feasibility, Acceptability and Effectiveness of Laparoscopic Adjustable Gastric Banding
Diabetes and obesity are common and serious health challenges for indigenous people worldwide. The feasibility of achieving substantial weight loss, leading to remission of diabetes, was evaluated in a regional indigenous Australian community.
A prospective cohort study of 30 obese indigenous adults from the Rumbalara Aboriginal Co-operative in Central Victoria was performed. Inclusion criteria included aboriginality, BMI > 30 kg/m2 and diabetes diagnosed within the last 10 years. Weight loss was achieved using laparoscopic adjustable gastric banding (LAGB). Participants were treated in their community and followed for 2 years. Outcomes were compared with those of non-indigenous Australians from an earlier randomized controlled trial (RCT) using a similar protocol.
30 participants (26 females, mean age 44.6 years; mean BMI 44.3) had LAGB at the regional hospital. Twenty-six participants completed diabetes assessment at 2 years follow-up. They showed diabetes remission (fasting blood glucose < 7.0 mmol/L and haemoglobin A1c (HbA1c) < 6.2 % while off all therapy except metformin) in 20 of the 26 and a mean weight loss (SD) of 26.0 (14) kilograms. Based on intention-to-treat, remission rate was 66 %. Quality of life improved. There was one early event and 12 late adverse events. The outcomes for weight loss and diabetes remission were not different from the LAGB group of the RCT.
For obese indigenous people with diabetes, a regionalized model of care centred on the LAGB is an effective approach to a serious health problem. The model proved feasible and acceptable to the indigenous people.
Australian New Zealand Clinical Trials Registry (ACTRN 12609000319279).
KeywordsType 2 diabetes Obesity Bariatric surgery Gastric banding LAGB Indigenous Aboriginal Remission of diabetes Weight loss
Laparoscopic adjustable gastric band
Medical Outcomes Trust 36-Item Health Survey
Rumbalara Aboriginal Co-operative
Victorian Aboriginal Community Controlled Health Organisation
Centre for Obesity Research and Education
Statistical Package for the Social Sciences
We acknowledge the excellent cooperation and support provided by the staff at the Rumbalara Health Service and at the Goulburn Valley Hospital. We appreciate the support and assistance of the Aboriginal communities of Central Victoria.
Conflict of Interest
The authors have completed the ICMJE Form for Disclosure of Potential Conflicts of Interest. Paul O'Brien reported being the Emeritus Director of the Centre for Obesity Research and Education (CORE) at Monash University which receives a grant from Allergan for research support. The grant is not tied to any specified research projects, and Allergan has no control of the protocol, analysis and reporting of any studies. CORE also receives a grant from Applied Medical towards educational programs. He has written a patient information book entitled “The Lap-Band Solution: A Partnership for Weight Loss” which is given to patients without charge, but some are sold to surgeons and others for which he receives a royalty.
Dawn DeWitt, Cheryl Laurie, Leah Brennan, John Wentworth, Margaret Anderson, Kerin O’Dea, Felicia Dean, Andrew Smith and David Dalton did not report any disclosures.
The study was funded by a grant from the National Health and Medical Research Council—NHMRC Project grant no.546018.
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