Diabetes Outcomes More than a Decade Following Sustained Weight Loss After Laparoscopic Adjustable Gastric Band Surgery
Long-term outcome data are needed to define the role of bariatric surgery in type 2 diabetes (T2D). To address this, we collated diabetes outcomes more than a decade after laparoscopic adjustable gastric band (LAGB) surgery.
Clinical and biochemical measures from 113 obese T2D patients who underwent LAGB surgery in 2003 and 2004 were analyzed. Diabetes remission was defined as HbA1c < 6.2% (44 mmol/mol) and fasting glucose < 7.0 mmol/L.
Seventy-nine patients had weight data at 10 years and attained a median [Q1, Q3] weight loss of 16 [10, 21] percent. Sixty patients attended a follow-up assessment. Their baseline HbA1c of 7.8 [7.1, 9.3] percentage units (62 [54, 78] mmol/mol) had decreased to 6.6 [6.1, 8.4] (49 [43, 68] mmol/mol) despite no significant change in glucose-lowering therapy. Eleven patients (18%) were in diabetes remission and another 18 had HbA1c ≤ 6.5%. Significant improvements in physical measures of quality of life, blood pressure, and lipid profile were also observed but there was no change in the proportion of patients with albuminuria and a significant decline in estimated glomerular filtration rate. Twelve patients in the follow-up cohort (20%) required anti-reflux medication after surgery and 26 (43%) underwent gastric band revision surgery.
Weight loss for over 10 years after LAGB surgery delivers clinically meaningful improvements in HbA1c, blood pressure, lipids, and quality of life at the cost of a high rate of revision surgery and increased use of anti-reflux medication. These findings support the use of bariatric surgery as a long-term treatment for weight loss and wellbeing in patients with T2D.
Registered with the Australian Clinical trials registry as ACTRN12615000089538.
KeywordsBariatric surgery Type 2 diabetes Obesity Long-term Outcomes Quality of life Laparoscopic adjustable gastric band
We are grateful to our patients for their assistance. This work was supported by a competitive Diabetes Research Grant from Novo Nordisk, through Victorian State Government Operational Infrastructure Support and NHMRC Research Institute Infrastructure Support Scheme.
JMW conceived the study. PEO, PRB, WAB, and SS provided surgical care and, with JMW, CL and CC collated the data. JMW and CC analyzed the data. JMW drafted the manuscript and all authors reviewed and edited it. JMW is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Compliance with Ethical Standards
Conflict of Interest
Prof O’Brien and Prof Brown report being affiliated with the Centre for Obesity Research and Education. The Centre has received funding for research purposes from Allergan and Apollo Endosurgery, the manufacturers of the Lap-Band™. The grant was not tied to any specific research project, and neither Allergan nor Apollo Endosurgery has no control of the protocol, analysis and reporting of any studies. CORE also receives a grant from Applied Medical towards educational programs. Prof Brown reports financial support for a bariatric surgery registry from the Commonwealth of Australia, Apollo Endosurgery, Covidien, Johnson and Johnson, Gore and Applied Medical. Since initial submission of this paper, she has also received a speaker’s honorarium from Merck Sharpe and Dohme and a speaker’s honorarium and fees from participation in a scientific advisory board from Novo Nordisk. The Bariatric Registry and the honorariums are outside of the submitted work. Prof O’Brien 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. Dr. Burton reports personal fees from Covidien, outside the submitted work. No other author has a conflict of interest to declare.
Statement of Informed Consent
Informed consent was obtained from all individual participants who comprised the ‘Included Group’ in the study.
Statement of Human Rights
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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