17 Nov 2017

Lap Band study shows positive outcomes for diabetes patients

Prof Wendy Brown and her team perform
a gastric banding procedure
by Anne Crawford

A Monash University study on the effect of bariatric surgery on obese people with type 2 diabetes has showed that most patients experienced sustained weight loss with nearly a fifth in remission from the disease. Moreover, many patients reported improved quality of life. Obesity is a key risk factor for diabetes.


The study, which spanned more than 10 years, was the first long-term investigation of its kind. It was led by Monash University Centre for Obesity Research and Education (CORE) researchers Dr John Wentworth, Emeritus Professor Paul O’Brien and Professor Wendy Brown.

The researchers collated data from 113 obese type 2 diabetes patients who underwent laparoscopic adjustable gastric band (Lap Band) surgery in 2003 and 2004. The surgery places an adjustable band around the top part of the stomach to restrict food intake.

About 70 per cent (79 patients) had a sustained weight loss of 16 per cent of body weight over 12 years with 18 per cent (11 patients) in diabetes remission. Another 18 patients showed significant improvements in glycated haemoglobin tests (HbA1c) or blood sugar tests, used as a main measure of how diabetes is being controlled.

“The weight loss tended to correlate with improvements in HbA1c, which was striking,”
Dr Wentworth said. “This was despite the fact that people were taking pretty much the same level of diabetes medication, so it’s making the point that weight loss had been useful in lowering the blood sugar levels,” he said.

“The other really outstanding finding was that people felt a lot better – their quality of life was vastly improved, particularly their physical quality of life.”

The patients also experienced improvements in blood pressure and in lipid tests, which show the amount of cholesterol and fats in the blood and help predict the risk of cardiovascular disease.

Dr Wentworth said that while there had been studies of groups of patients who had had the other main bariatric operations – sleeve gastrectomy and gastric bypass – that long-term data on patients who had undergone Lap Band surgery had previously been lacking.

“This study makes the point that if you do good Lap Band surgery you get a good clinical result,” he said. “We now need to move beyond quality of life to measuring hard health outcomes in particular, such as does it save lives, does it prevent kidney disease and heart attack?

“You’ve got to keep providing evidence to change practice and to know whether the benefits of the surgery justify the upfront cost.”

Lap Band surgery costs about $10,000.

The study, published in the journal ‘Obesity Surgery’, found that the benefits of the surgery came at the cost of a high rate of revision surgery (43 per cent) and increased use of anti-reflux medication (20 per cent). Revision surgery was sometimes needed to replace the band and was conducted as a day procedure, Dr Wentworth said.

Reference

Wentworth JM, Cheng C, Laurie C, Skinner S, Burton PR, Brown WA, O'Brien PE. Diabetes Outcomes More than a Decade Following Sustained Weight Loss After Laparoscopic Adjustable Gastric Band Surgery. Obes Surg. 2017 Oct 3. doi: 10.1007/s11695-017-2944-7. [Epub ahead of print]


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