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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.

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]