Lap band surgery helps treat type 2 diabetes in the overweight: study

8 Apr 2014

The first Australian study of gastric banding in overweight people rather than obese people with type 2 diabetes found that more than half went into remission within two years of having the day surgery procedure, followed by sessions with a dietician and physician to monitor their health.

Lap band surgery can be an effective treatment for type 2 diabetes in people who are overweight but not obese, a small but potentially game-changing study has found.

Julia Medew - The Age

Researchers from the Centre for Obesity Research and Education at Monash University studied a group of 51 people aged 18 to 65 who were recently diagnosed with type 2 diabetes and had a body mass index of 25 to 30. These people were randomly allocated to either multidisciplinary standard care for diabetes or standard care with an adjustable gastric band inserted around their stomachs during laparoscopic surgery.

Multidisciplinary care involved consultations with a doctor every three to six months and sessions with a dietician. All participants were advised to do 150 minutes of moderate exercise each week.

Two years on, the average weight loss in the gastric band group was 11.5 kilograms and 12 of the 25 participants were in remission, which was defined as a glucose concentration of less than 7.0 mmol/L at fasting.

In the non-gastric band group, the average weight loss was 1.6 kilograms and only 8 per cent – or 2 of the 23 participants who completed two years in the study – were in remission.

One participant in the gastric band group needed revision surgery to move the band and four people experienced five episodes of "food intolerance" due to the band being too tight.

While weight loss surgery is generally only done for severely obese people in Australian public hospitals, the researchers said the study showed gastric band surgery should be considered for overweight people too.

In private hospitals, the procedure costs about $10,000 to $13,000 if you do not have private health insurance.

"We conclude that laparoscopic adjustable gastric band surgery combined with multidisciplinary diabetes care for overweight people with type 2 diabetes is more effective for control of blood glucose concentrations than is multidisciplinary care alone," they wrote in the Lancet Diabetes and Endocrinology medical journal.

"The favourable safety profile and widespread acceptance of laparoscopic adjustable gastric band surgery argue for a more prominent place for this surgery in management of type 2 diabetes in overweight people."

One of the researchers and Emeritus Professor of Surgery at Monash University Paul O'Brien said that although the study was funded by Allergan – a gastric band manufacturer – the company had no role in the design or interpretation of the study which was independent.

Body mass index is a tool that uses a person's height and weight to classify them as underweight, healthy, overweight, obese or severely obese. A BMI of 25-30 is overweight.

About 60 per cent of Australians now have a BMI over 25, and in 2012 the Australian Bureau of Statistics reported the average Australian male was 176 centimetres tall and weighed 86 kilograms, with a BMI of 27. The average Australian woman also had a BMI of 27, standing 162 centimetres tall and weighing 71 kilograms.

Professor O'Brien said about 5 per cent of the 1 million Australians with type 2 diabetes were of a healthy weight and that the AusDiab study suggested about half of the remaining 95 per cent were overweight, with the other half obese.

Chief executive of Diabetes Australia Professor Greg Johnson said that although weight loss improved management of type 2 diabetes in some people, his group believed current evidence only supported bariatric surgery for severely obese people who have already tried losing weight with lifestyle changes.

Furthermore, he said this study was too small to draw conclusions and that bariatric surgery carried many risks.

"We would need much larger numbers in the study to look at complications," he said.

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