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A comparative study of the adjustable gastric banding and the conventional therapy used for the treatment of type 2 diabetes is presented. The surgical therapy is found to be more effective for the treatment, as it leads to greater weight loss.

The article focuses on the pharmacological principle and clinical evidence behind the combination of glucagon-like peptide-1 (GLP-1) receptor agonists and basal insulin for the treatment of type 2 diabetes mellitus (T2DM). It states that the combination of GLP-1 receptor agonists with basal insulin provides an alternative approach to enhance the efficiency of insulin therapy. It adds that the existing clinical data are not sufficient to support the long-term effects of GLP-1 receptor agonists.

Background: Obesity is now one of our major public health problems. Effective and acceptable treatment options are needed.The Lap-Band® system is placed laparoscopically and allows adjustment of the level of gastric restriction. Methods: A prospective study of 709 severely obese patients was conducted over a 6-year period at a university-based multidisciplinary referral center. After extensive preoperative evaluation, patients with a body mass index >35 were treated by LapBand® placement. Close follow-up with progressive adjustment of gastric restriction continued permanently. Medical co-morbidities were monitored as part of comprehensive prospective data collection. Results: There have been no deaths perioperatively or during follow-up. Significant perioperative adverse events occurred in 1.2% only. Reoperation has been needed for prolapse (slippage) in 12.5%, erosion of the band into the stomach in 2.8% and for tubing breaks in 3.6%. A steady progression of weight loss has occurred through the duration of the study with 52 ± 19 %EWL at 24 months (n=333), 53±22 %EWL at 36 months (n=264), 52 ± 24 %EWL at 48 months (n=108), 54 ± 24 %EWL at 60 months (n=30), and 57 ± 15% EWL at 72 months (n=10). Major improvements have occurred in diabetes, asthma, gastroesophageal reflux, dyslipidemia, sleep apnea and depression. Quality of life as measured by Rand SF-36 shows highly significant improvement. Conclusions: Placement of the Lap-Band® system provides safe and effective control of severe obesity. The effect on weight loss is durable and is associated with major improvement in health and quality of life. It has the potential to provide a broadly acceptable option for this common and serious disease. [ABSTRACT FROM AUTHOR]

Background: Type-2 diabetes is strongly driven by obesity. Observational studies suggest that weight loss through bariatric surgery is more effective than conventional therapy for the management of type-2 diabetes, but no randomized controlled trial has been performed. Methods: We conducted a 2-year randomized controlled trial involving 60 obese (BMI > 30 and < 40 kg/m2) subjects with recently diagnosed (<2years) typo-2 diabetes. Subjects drawn from the general community were randomly allocated to either a program of conventional diabetes therapy with an intensive lifestyle change to induce weight loss or had substantial weight loss induced by the placement of a laparoscopic adjustable gastric band (LAGB; LAP-BAND®, Allergan Health) in addition to conventional care. The intensity of programs was similar. Key outcome measures were diabetes remission (fasting plasma glucose <7mmol/l, plus HbA1c <6.2% while taking no hypoglycaemic drug therapy or insulin), HbA1c levels, indirect measures of insulin resistance, and presence of metabolic syndrome. Results: At 2 years, the LAGB group and conventional groups had lost mean (SD) of 20.7 (8.6) % and 1.7 (5.2) % of weight respectively (P <0.001). Remission of diabetes was achieved by 22 of 29 (76%) the LAGB, and 4 of 26 (15%) of the conventional 2-year completers (p<0.001). Weight loss was the major driver of remission (R2 =0.46, p<0.001), with a 13% weight loss cutoff providing an 85% sensitivity and 86% specificity for remission. HbA1c levels fell 22.5 (11.6) % in the LAGB and 5.4 (15.2) % in the conventionally treated groups. The surgical group also had greater improvements in fasting plasma glucose, insulin, triglycerides and HDL-cholesterol. The metabolic syndrome was present in 29 of 30 in each group initially and in 8 of 29 LAGB and 22 of 26 conventional groups at 2 years. There were no serious complications in either treatment group. Conclusions: There is a direct relationship between weight loss and remission of type 2 diabetes in obese subjects. Substantial weight loss induced by LAGB is associated with a significantly better outcome than conventional therapy. LAGB placement should be considered when planning a treatment program for obese subjects diagnosed with type-2 diabetes. [ABSTRACT FROM AUTHOR]

Background: Obesity is a major, growing health problem. Observational studies suggest that bariatric surgery is more effective than nonsurgical therapy, but no randomized, controlled trials have confirmed this., Objective: To ascertain whether surgical therapy for obesity achieves better weight loss, health, and quality of life than nonsurgical therapy., Design: Randomized, controlled trial., Setting: University departments of medicine and surgery and an affiliated private hospital., Patients: 80 adults with mild to moderate obesity (body mass index, 30 kg/m2 to 35 kg/m2) from the general community., Interventions: Patients were assigned to a program of very-low-calorie diets, pharmacotherapy, and lifestyle change for 24 months (nonsurgical group) or to placement of a laparoscopic adjustable gastric band (LAP-BAND System, INAMED Health, Santa Barbara, California) (surgical group)., Measurements: Outcome measures were weight change, presence of the metabolic syndrome, and change in quality of life at 2 years., Results: At 2 years, the surgical group had greater weight loss, with a mean of 21.6% (95% CI, 19.3% to 23.9%) of initial weight lost and 87.2% (CI, 77.7% to 96.6%) of excess weight lost, while the nonsurgical group had a loss of 5.5% (CI, 3.2% to 7.9%) of initial weight and 21.8% (CI, 11.9% to 31.6%) of excess weight (P < 0.001). The metabolic syndrome was initially present in 15 (38%) patients in each group and was present in 8 (24%) nonsurgical patients and 1 (3%) surgical patient at the completion of the study (P < 0.002). Quality of life improved statistically significantly more in the surgical group (8 of 8 subscores of Short Form-36) than in the nonsurgical group (3 of 8 subscores)., Limitations: The study included mildly and moderately obese participants, was not powered for comparison of adverse events, and examined outcomes only for 24 months., Conclusions: Surgical treatment using laparoscopic adjustable gastric banding was statistically significantly more effective than nonsurgical therapy in reducing weight, resolving the metabolic syndrome, and improving quality of life during a 24-month treatment program.

Psychotic illness and its treatment are associated with an increased rate of diabetes and worsening blood sugar control, Australia. The newer, second-generation antipsychotic agents are more likely to produce this effect than the first-generation agents, but both contribute to the problem. The effect is usually related to insulin resistance through weight gain, but other mechanisms may exist. Diabetic ketoacidosis is rare. Management of psychosis takes priority over concerns about the potential metabolic sequelae of treatment, but the prevalence of the latter requires that all patients taking antipsychotic agents be actively screened and treated. Patients treated with antipsychotic agents need baseline and regular checks, including weight, blood glucose and lipid levels and blood pressure. Management of psychosis with its attendant medical problems requires a multidisciplinary approach, with primary health practitioners playing a central role. Mortality and medical morbidity is higher in those with psychosis than expected; preventive measures, combined with early detection and treatment of hyperglycaemia and other metabolic problems, is a key public health issue.