One of the health hazards of obesity is type 2 diabetes. Almost half of those diagnosed with diabetes are obese and among those who are obese, the risk of developing diabetes increases dramatically as weight increases. Although obesity is the primary cause of diabetes, studies show that losing as little as 5-10% of body weight can prevent the onset of diabetes. In those who already have the condition, weight loss can improve or even cure the problem.
It is well known that following gastric bypass surgery, around 80% of type 2 diabetics will be cured. Moreover, the improvement in diabetes appears to be largely independent of weight loss. Laparoscopic adjustable gastric banding (LAGB) tends to result in less weight loss than bypass, yet many studies have shown a highly beneficial effect on type 2 diabetes. This is important since many patients would prefer LAGB over bypass surgery because it is a reversible procedure and has a lower risk of complications. A recently published review by Dixon et al provides a comprehensive analysis of the impact of LAGB on type 2 diabetes.
What the evidence shows overall is that diabetes remission (cure) rates following LAGB decline from around 62% at 6-months to 55% at 12-24 months and finally to around 38% after more than 2-years follow-up. This downward trend in cure-rates over time is consistent with studies from gastric bypass patients which show a similar decline. The good news, however, is that although remission rates declined after LAGB, when combined with diabetic improvements such as better control of blood sugars and less medication, the longest term studies reveal remission or improvements in over 60% of LAGB patients.
It might be thought that the decline in remission rates over time could be due to weight regain after LAGB, but the evidence does not support this. Excess weight loss (EWL) increased from 34.8% at 12 months to 47% at 24 months, before leveling off at 44.8% beyond 2-years follow-up.
These improvements in type 2 diabetes are very encouraging and significantly better than the impact of non-surgical weight-loss programmes.
Dr David Ashton MD PhD
19th July 2012
Dixon JB, Murphy DK, Segel JE, Finkelstein EA. Impact of laparoscopic adjustable gastric banding on type 2 diabetes. Obesity Reviews 2012: 13:57-67: http://www.ncbi.nlm.nih.gov/pubmed/21880108