Laparoscopic Gastric Banding Prevents Type 2 Diabetes and Arterial Hypertension and Induces Their Remission in Morbid Obesity

Abstract

OBJECTIVE -Lifestyle modifications and pharmacological interventions can prevent type 2 diabetes in obese subjects with impaired glucose tolerance. The aim of this study was to compare laparoscopic adjustable gastric banding (LAGB) and conventional diet (No-LAGB) in the prevention (primary intervention study; 56 vs. 29 patients) and remission (secondary intervention study; 17 vs. 20 patients) of type 2 diabetes and hypertension in grade 3 obesity in a 4-year study.RESEARCH DESIGN AND METHODS -The subjects (n ϭ 122; age 48.5 Ϯ 1.05 years; BMI 45.7 Ϯ 0.67 kg/m 2 ) underwent a diagnostic workup, including psychological and psychiatric assessments, in preparation for the LAGB procedure. Of the 122 subjects, 73 had the surgery (LAGB group). The control group (No-LAGB group) consisted of the 49 subjects who refused the surgery but agreed to be followed up; 6 of these subjects dropped out by the 2nd year of the study, so that the final number of patients was 73 and 43 in the LAGB and No-LAGB groups, respectively. All patients had a yearly visit and oral glucose tolerance test.RESULTS -From baseline to the end of the 4-year follow-up, BMI decreased from 45.9 Ϯ 0.89 at baseline to 37.7 Ϯ 0.71 kg/m 2 in the LAGB group and remained steady in the No-LAGB group (from 45.2 Ϯ 1.04 to 46.5 Ϯ 1.37 kg/m 2 ), with no significant differences between the primary and secondary intervention groups. In the primary intervention study, five of the No-LAGB subjects (17.2%) and none of the LAGB subjects (0.0%; P ϭ 0.0001) progressed to type 2 diabetes; in the secondary intervention study, type 2 diabetes remitted in one No-LAGB patient (4.0%) and seven LAGB patients (45.0%; P ϭ 0.0052). Hypertension occurred in 11 No-LAGB patients (25.6%) and 1 LAGB patient (1.4%; P ϭ 0.0001) and remitted in 1 No-LAGB (2.3%) and 15 LAGB patients (20.5%; P ϭ 0.0001). A study of body mass composition revealed a significant reduction of fat mass and a transitory, but not significant, decrease of fat-free mass in LAGB patients.CONCLUSIONS -In morbid obesity, sustained and long-lasting weight loss obtained through LAGB prevents the occurrence of type 2 diabetes and hypertension and decreases the prevalence of these disorders. Diabetes Care 28:2703-2709, 2005O besity is a major risk factor for certain diseases, particularly cardiovascular disease. The risk is proportional to BMI and duration of obesity and increases with visceral obesity (1-6). Obesity, especially when associated with impaired glucose tolerance (IGT), is a leading cause of type 2 diabetes (7). Several large studies have demonstrated that it is possible to prevent the progression from IGT to type 2 diabetes by dietary intervention, lifestyle modifications (including physical activity), and drugs (8 -13). In some cases, these therapeutic approaches reduce cardiovascular morbidity and mortality in type 2 diabetes (14,15). Obesity and type 2 diabetes are often complicated by arterial hypertension, a link that is allegedly mediated by increased sympathetic tone (16); left ventricular hypertrophy is f...

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