Diabetologia

, Volume 57, Issue 3, pp 463–468 | Cite as

Laparoscopic adjustable gastric banding and progression from impaired fasting glucose to diabetes

  • John M. Wentworth
  • Tamishta Hensman
  • Julie Playfair
  • Cheryl Laurie
  • Matthew E. Ritchie
  • Wendy A. Brown
  • Stewart Skinner
  • Jonathan E. Shaw
  • Paul E. O’Brien
Article

Abstract

Aims/hypothesis

Obesity and dysglycaemia are major risk factors for type 2 diabetes. We determined if obese people undergoing laparoscopic adjustable gastric banding (LAGB) had a reduced risk of progressing from impaired fasting glucose (IFG) to diabetes.

Methods

This was a retrospective cohort study of obese people with IFG who underwent LAGB. Weight and diabetes outcomes after a minimum follow-up period of 4 years (mean ± SD 6.1 ± 1.7 years) were compared with those of Australian adults with IFG from a population-based study (AusDiab).

Results

We identified 281 LAGB patients with baseline IFG. Their mean ± SD age and BMI were 46 ± 9 years and 46 ± 9 kg/m2, respectively. The diabetes incidence for patients in the lowest, middle and highest weight loss tertile were 19.1, 3.4 and 1.8 cases/1,000 person-years, respectively. The AusDiab cohort had a lower BMI (28 ± 5 kg/m2) and a diabetes incidence of 12.5 cases/1,000 person-years. This increased to 20.5 cases/1,000 person-years when analysis was restricted to the 322 obese AusDiab participants, which was higher than the overall rate of 8.2 cases/1,000 person-years seen in the LAGB group (p = 0.02). Multivariable analysis of the combined LAGB and AusDiab data suggested that LAGB was associated with ∼75% lower risk of diabetes (OR 0.24 [95% CI 0.10, 0.57], p = 0.004).

Conclusions/interpretation

In obese people with IFG, weight loss after LAGB is associated with a substantially reduced risk of progressing to diabetes over ≥4 years. Bariatric surgery may be an effective diabetes prevention strategy in this population.

Keywords

Bariatric surgery Diabetes prevention Impaired fasting glucose Obesity 

Abbreviations

FPG

Fasting plasma glucose

IFG

Impaired fasting glucose

IGT

Impaired glucose tolerance

LAGB

Laparoscopic adjustable gastric banding

SOS

Swedish Obese Subjects

References

  1. 1.
    Zimmet P, Alberti KG, Shaw J (2001) Global and societal implications of the diabetes epidemic. Nature 414:782–787PubMedCrossRefGoogle Scholar
  2. 2.
    American Diabetes Association (2013) Standards of medical care in diabetes–2013. Diabetes Care 36(Suppl 1):S11–S66Google Scholar
  3. 3.
    Edelstein SL, Knowler WC, Bain RP et al (1997) Predictors of progression from impaired glucose tolerance to NIDDM: an analysis of six prospective studies. Diabetes 46:701–710PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Burke JP, Williams K, Narayan KM, Leibson C, Haffner SM, Stern MP (2003) A population perspective on diabetes prevention: whom should we target for preventing weight gain? Diabetes Care 26:1999–2004PubMedCrossRefGoogle Scholar
  5. 5.
    Ramachandran A, Snehalatha C, Mary S et al (2006) The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 49:289–297PubMedCrossRefGoogle Scholar
  6. 6.
    Knowler WC, Barrett-Connor E, Fowler SE et al (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346(6):393–403PubMedCrossRefGoogle Scholar
  7. 7.
    Tuomilehto J, Lindstrom J, Eriksson JG et al (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344:1343–1350PubMedCrossRefGoogle Scholar
  8. 8.
    Li G, Zhang P, Wang J et al (2008) The long-term effect of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20-year follow-up study. Lancet 371(9626):1783–1789PubMedCrossRefGoogle Scholar
  9. 9.
    Chiasson JL, Josse RG, Gomis R et al (2002) Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet 359:2072–2077PubMedCrossRefGoogle Scholar
  10. 10.
    DeFronzo RA, Tripathy D, Schwenke DC et al (2011) Pioglitazone for diabetes prevention in impaired glucose tolerance. N Engl J Med 364:1104–1115PubMedCrossRefGoogle Scholar
  11. 11.
    Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L (2004) XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care 27:155–161PubMedCrossRefGoogle Scholar
  12. 12.
    Garvey WT, Ryan DH, Look M et al (2012) Two-year sustained weight loss and metabolic benefits with controlled-release phentermine/topiramate in obese and overweight adults (SEQUEL): a randomized, placebo-controlled, phase 3 extension study. Am J Clin Nutr 95:297–308PubMedCrossRefGoogle Scholar
  13. 13.
    O’Brien P, McDonald L, Anderson M, Brennan L, Brown WA (2013) Long term outcomes after bariatric surgery: fifteen year follow up after gastric banding and a systematic review of the literature. Ann Surg 257:87–94PubMedCrossRefGoogle Scholar
  14. 14.
    Dixon JB, O’Brien PE, Playfair J et al (2008) Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. J Am Med Assoc 299:316–323Google Scholar
  15. 15.
    Mingrone G, Panunzi S, De Gaetano A et al (2012) Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 366(17):1577–1585PubMedCrossRefGoogle Scholar
  16. 16.
    Schauer PR, Kashyap SR, Wolski K et al (2012) Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 366(17):1567–1576PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Carlsson LM, Peltonen M, Ahlin S et al (2012) Bariatric surgery and prevention of type 2 diabetes in Swedish obese subjects. N Engl J Med 367(8):695–704PubMedCrossRefGoogle Scholar
  18. 18.
    Magliano DJ, Barr EL, Zimmet PZ et al (2008) Glucose indices, health behaviors, and incidence of diabetes in Australia: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care 31(2):267–272PubMedCrossRefGoogle Scholar
  19. 19.
    American Diabetes Association (2010) Standards of medical care in diabetes - 2010. Diabetes Care 33(Suppl 1):S11–S61Google Scholar
  20. 20.
    Dunstan DW, Zimmet PZ, Welborn TA et al (2002) The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care 25:829–834PubMedCrossRefGoogle Scholar
  21. 21.
    Gregg EW, Chen H, Wagenknecht LE et al (2012) Association of an intensive lifestyle intervention with remission of type 2 diabetes. J Am Med Assoc 308:2489–2496CrossRefGoogle Scholar
  22. 22.
    Colditz GA, Willett WC, Stampfer MJ et al (1990) Weight as a risk factor for clinical diabetes in women. Am J Epidemiol 132:501–513PubMedGoogle Scholar
  23. 23.
    Hu FB, Manson JE, Stampfer MJ et al (2001) Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med 345:790–797PubMedCrossRefGoogle Scholar
  24. 24.
    Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC (1994) Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 17(9):961–969PubMedCrossRefGoogle Scholar
  25. 25.
    Cobourn C, Mumford D, Chapman MA, Wells L (2010) Laparoscopic gastric banding is safe in outpatient surgical centers. Obes Surg 20:415–422PubMedCrossRefGoogle Scholar
  26. 26.
    Longitudinal Assessment of Bariatric Surgery C, Flum DR, Belle SH et al (2009) Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 361:445–454PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • John M. Wentworth
    • 1
    • 2
  • Tamishta Hensman
    • 1
  • Julie Playfair
    • 1
  • Cheryl Laurie
    • 1
  • Matthew E. Ritchie
    • 2
    • 3
  • Wendy A. Brown
    • 1
  • Stewart Skinner
    • 1
  • Jonathan E. Shaw
    • 4
  • Paul E. O’Brien
    • 1
  1. 1.Centre for Obesity Research and Education (CORE)Monash University at The Alfred CentreMelbourneAustralia
  2. 2.Molecular Medicine DivisionWalter and Eliza Hall InstituteMelbourneAustralia
  3. 3.Department of Mathematics and StatisticsThe University of MelbourneMelbourneAustralia
  4. 4.Baker IDI Heart and Diabetes InstituteMelbourneAustralia

Personalised recommendations