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Gastric Band Surgery Leads to Improved Insulin Secretion in Overweight People with Type 2 Diabetes

Abstract

Background

We aimed to determine the effects of laparoscopic adjustable gastric band (LAGB) on beta-cell function in overweight people with type 2 diabetes and to assess the relationship between baseline beta-cell function and glycemic outcomes.

Methods

We studied 44 overweight but not obese people with type 2 diabetes who participated in a randomized trial whose primary outcome was the rate of diabetes remission after 2 years of multidisciplinary diabetes care (MDC group) or multidisciplinary care combined with LAGB. Dynamic beta-cell function was assessed by intravenous glucose challenge, and basal beta-cell function (HOMA-B) and insulin sensitivity (HOMA-S) were determined using the homeostatic model.

Results

Twelve LAGB participants and two MDC participants were in diabetes remission at 2 years. HOMA-S and the C-peptide response to intravenous glucose increased significantly in LAGB but not in MDC participants. The insulin response to glucose did not change in LAGB participants, whereas their fasting C-peptide/insulin ratio increased. Baseline measures of beta-cell function correlated with diabetes remission but not with reduction in HbA1c following LAGB.

Conclusions

In overweight people with diabetes, LAGB improves endogenous beta-cell function after 2 years. Baseline beta-cell function correlated with diabetes remission, but not with HbA1c change following LAGB.

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Acknowledgments

We are grateful to the participants for their commitment to this study and to Professor Glenn Ward and Dr. Matt Ritchie for helpful discussion. Maria Bisignano performed glucose, insulin, and C-peptide assays. This study was funded by the Center for Obesity Research and Education (CORE), Monash University. CORE receives grants from the Allergan and Applied Medical for research and educational support. The grants are not tied to any specified research projects, and the grantors have no control over the protocol, analysis, and reporting of any studies. Allergan donated the lap-band prostheses used in this study. The work was also supported by Victorian State Government Operational Infrastructure Support and Australian Government NHMRC IRIISS. JES is supported by a National Health and Medical Research Council Fellowship (586623).

Statement of Ethical Approval

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.

Conflict of Interest

Paul Burton has received an honorarium to speak at an education conference from Covidien Australia, the manufacturer of surgical stapling devices that are used in procedures designed to treat obesity. No other author reports a conflict of interest.

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Correspondence to John M. Wentworth.

Electronic supplementary material

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Supplementary Figure

IVGTT outcomes according to weight loss at 2 years. Median glucose, insulin, and C-peptide responses to intravenous glucose for each weight loss tertile. Statistical comparisons at each timepoint were performed by t test as indicated with 1 and 2 symbols representing p < 0.05 and p < 0.01, respectively. Median [Q1, Q3] AUC data are provided in the Supplementary Table (PDF 80 kb)

Supplementary Table

(DOCX 55 kb)

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Wentworth, J.M., Playfair, J., Laurie, C. et al. Gastric Band Surgery Leads to Improved Insulin Secretion in Overweight People with Type 2 Diabetes. OBES SURG 25, 2400–2407 (2015). https://doi.org/10.1007/s11695-015-1716-5

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Keywords

  • Bariatric surgery
  • Type 2 diabetes
  • IVGTT
  • First-phase insulin release
  • Beta-cell function
  • Weight loss
  • Diabetes remission