The Impact of Laparoscopic Adjustable Gastric Banding on an NHS Cohort of Type 2 Diabetics: a Prospective Cohort Study.

backgroundObesity is an independent risk factor for diabetes, which is associated with significant morbidity and premature death. This study aims to evaluate the impact of laparoscopic adjustable gastric banding (LAGB) on a cohort of morbidly obese diabetics.

methodsInclusion and exclusion criteria were applied to consecutive diabetic patients undergoing LAGB. Demographic and disease-specific data were collected at baseline and 6-monthly intervals corresponding to follow-up assessments. Minimum follow-up was 24 months. Normally distributed variables were assessed with one-way analysis of variance/t tests; proportions were analysed with chi-squared/Fisher's exact tests. Follow-up was ≥90 % complete at each time point.

resultsOne hundred twenty patients with a median age of 43.3 years, mean (± standard deviation (SD)) pre-op body mass index (BMI) of 48.7 (±8) kg/m2, and HbA1c of 8.6 (±2) % were included. BMI reduced significantly, with annual post-operative means of 41.4 ± 7.8, 39.9 ± 7.7, 39.5 ± 7.8, 39.3 ± 7.1 and 36.6 ± 5.4 kg/m(2) (p < 0.001). Corresponding percentage excess body weight lost was 32.8 ± 18, 39.8 ± 21.4, 38.5 ± 21.3, 37.0 ± 22.3 and 43.1 ± 14.1 %. HbA1c was significantly lower at each time point until 30 months post-operatively (p < 0.001). Thereafter, differences were insignificant, and HbA1c was comparable to pre-operative levels by 5 years. Seventy-six (63 %) patients achieved an HbA1c <7 % at 30 months (p < 0.001). Twenty-six (23 %) patients achieved remission from diabetes. The cumulative 5-year cost saving from reductions in anti-diabetes medications was £1650/patient. There were no mortalities, and 18 device explants.

conclusionsModest but durable weight loss associated with significant improvements in glycaemic control and anti-diabetic medication use have been demonstrated. Peak effects occur within 24-30 months and diminish thereafter, possibly reflecting progression of pathological processes due to residual obesity.