A study published in January in The Journal of the American Medical Association found that gastric banding weight-loss surgery in obese people with Type 2 diabetes led to better blood glucose control and higher rates of diabetes reversal than lifestyle changes meant to help people lose weight. The surgery also helped people lose significantly more weight than lifestyle changes. This was the first randomized study comparing weight-loss surgery to conventional therapy for managing Type 2 diabetes in obese people.
For the study, researchers recruited 60 participants who had recently been diagnosed with Type 2 diabetes (in the last two years). Their body-mass indexes were between 30 and 40, putting them in the obese (but not morbidly obese) category. The participants were randomly assigned to two groups: One group received conventional diabetes care, emphasizing lifestyle changes (diet and exercise) to help them lose weight, while the other group received conventional diabetes care and laparoscopic adjustable gastric banding surgery.
This type of surgery places an adjustable ring around the upper part of the stomach, creating a new, smaller pouch that can hold less food. This decreases the amount of food that can be eaten at once and slows the passage of food through the stomach, causing a prolonged sense of fullness.
The researchers wanted to see whether weight loss that resulted from the surgery would improve blood glucose control and lessen the need for diabetes drugs more than a traditional approach to Type 2 diabetes treatment.
Fifty-five of the participants completed the study. After two years, 73% of the people who had had gastric banding surgery had reversal, or remission, of diabetes compared to 13% of those in the lifestyle change group. (Remission of diabetes was defined as a fasting blood glucose level of less than 126 mg/dl and an HbA1c level of less than 6.2% without the help of blood-glucose-lowering therapy.) Also, members of the surgery group lost an average of 20% of their body weight, compared to an average loss of 1.7% of body weight in the lifestyle change group.
In both groups, a larger percentage of weight loss and a lower starting HbA1c level were associated with a higher chance of diabetes remission, with percentage weight loss having more of an effect.
The researchers commented that this study “presents strong evidence to support the early consideration of surgically induced loss of weight in the treatment of obsese patients with type 2 diabetes,” but also pointed out that its results need to be confirmed in larger, longer-term studies. What’s more, they concluded that the degree of weight loss, rather than the method by which it came about, was the most important factor for lowering blood glucose levels and reversing diabetes. People who lost more than 10% of their body weight—whether from surgery or from lifestyle changes—had a greater chance of reversing their diabetes.
The study took place at Monash University in Melbourne, Australia, and was funded by an unrestricted grant from Allergan Health, a company that manufactures laparoscopic adjustable gastric bands.
To learn more about weight-loss surgery and diabetes, please read the article “Bariatric Surgery: An Option for Long-Term Weight Loss.”