Adjustable Gastric Banding and Conventional Therapy for Type 2 Diabetes A Randomized Controlled Trial
John B. Dixon, MBBS, PhD; Paul E. O’Brien, MD; Julie Playfair, RN; Leon Chapman, MBBS; Linda M. Schachter, MBBS, PhD; Stewart Skinner, MBBS, PhD; Joseph Proietto, MBBS, PhD; Michael Bailey, PhD, MSc(stats); Margaret Anderson, BHealthMan
JAMA. 2008;299(3):316-323.
Context Observational studies suggest that surgically induced loss of weight may be effective therapy for type 2 diabetes.
Objective To determine if surgically induced weight loss results in better glycemic control and less need for diabetes medications than conventional approaches to weight loss and diabetes control.
Design, Setting, and Participants Unblinded randomized controlled trial conducted from December 2002 through December 2006 at the University Obesity Research Center in Australia, with general community recruitment to established treatment programs. Participants were 60 obese patients (BMI >30 and <40) with recently diagnosed (<2 years) type 2 diabetes.
Interventions Conventional diabetes therapy with a focus on weight loss by lifestyle change vs laparoscopic adjustable gastric banding with conventional diabetes care.
Main Outcome Measures Remission of type 2 diabetes (fasting glucose level <126 mg/dL [7.0 mmol/L] and glycated hemoglobin [HbA1c] value <6.2% while taking no glycemic therapy). Secondary measures included weight and components of the metabolic syndrome. Analysis was by intention-to-treat.
Results Of the 60 patients enrolled, 55 (92%) completed the 2-year follow-up. Remission of type 2 diabetes was achieved by 22 (73%) in the surgical group and 4 (13%) in the conventional-therapy group. Relative risk of remission for the surgical group was 5.5 (95% confidence interval, 2.2-14.0). Surgical and conventional-therapy groups lost a mean (SD) of 20.7% (8.6%) and 1.7% (5.2%) of weight, respectively, at 2 years (P < .001). Remission of type 2 diabetes was related to weight loss (R2 = 0.46, P < .001) and lower baseline HbA1c levels (combined R2 = 0.52, P < .001). There were no serious complications in either group.
Conclusions Participants randomized to surgical therapy were more likely to achieve remission of type 2 diabetes through greater weight loss. These results need to be confirmed in a larger, more diverse population and have long-term efficacy assessed.
Showing posts with label Bariatric Surgery. Show all posts
Showing posts with label Bariatric Surgery. Show all posts
Wednesday, January 23, 2008
Wednesday, August 22, 2007
Lower Weight From Surgery Shows Benefit
WALL STREET JOURNAL
Lower Weight From Surgery Shows Benefit
By WILLIAM M. BULKELEYAugust 23, 2007; Page D6
Two studies and an editorial in today's New England Journal of Medicine support gastric-bypass surgery as a way to significantly improve mortality rates in obese people. But the author of the editorial stopped short of endorsing more surgery because of economic concerns about expanding use of the $25,000 operation.
Gastric-bypass surgery has become an increasingly popular response to the obesity epidemic. The surgery, which shrinks the stomach and sometimes reroutes the intestines, has been widely shown to provide long-term weight loss.
Last year, surgeons performed 177,600 gastric-bypass operations in the U.S., according to the American Society for Metabolic and Bariatric Surgery.
Until now, evidence that the lower weight resulting from the surgery actually saves lives has been scant.
The first of the studies, from Utah, involving gastric-bypass patients and a control group, found the surgery patients' mortality rate improved by 40%. The other study, from Sweden, followed overweight people who had different kinds of weight-loss operations. It found they had 29% improved mortality during the study against comparably overweight people who didn't have surgery.
The Journal's editorialist, George Bray, chief of the division of clinical obesity at Pennington Biomedical Research Center at Louisiana State University, said in an interview that the studies are the equivalent of "the statin trials that showed the drugs reduced death rates and not just cholesterol." Following those studies, cholesterol-fighting statins became a huge business for the pharmaceutical industry.
Dr. Bray said the studies -- which included people who had surgery at relatively low levels of obesity -- make it clear that the National Institutes of Health should reconsider guidelines that suggest the surgery as an option for patients whose body-mass indexes surpass 40. Normal BMIs range up to 25, and people with BMIs above 30 are considered obese. However, Dr. Bray said he isn't willing to come out in favor of a lower standard because, "You'll break the bank."
The Swedish Obese Subjects Study followed 2,010 patients from when they had the operation for as long as 16 years and compared them with a group of comparable subjects based on BMI, gender and other factors. The study found that the surgical patients after 10 years had kept off between 14% and 25% of their original weight, depending on whether they had older surgery types or the more modern gastric bypass.
In the Swedish study, 101 of those who had the surgery died in the study period; of those who didn't have the surgery, 129 died. Deaths from heart disease and cancer were both sharply lower in the group that received surgery.
The Utah study, led by Ted Adams of the University of Utah, compared 7,925 people who had gastric-bypass surgery after 1984 with a similar number of severely obese people culled from driver's license rolls. Those who received surgery had 213 deaths, compared with 321 for the control group. Surgery patients had 56% fewer deaths from cardiovascular events, 60% fewer from cancer and 92% fewer deaths from diabetes. However, people who had the surgery had 15 deaths from suicide compared with five suicides among the control group. The study didn't theorize about reasons for the higher suicide rate.
Write to William M. Bulkeley
Lower Weight From Surgery Shows Benefit
By WILLIAM M. BULKELEYAugust 23, 2007; Page D6
Two studies and an editorial in today's New England Journal of Medicine support gastric-bypass surgery as a way to significantly improve mortality rates in obese people. But the author of the editorial stopped short of endorsing more surgery because of economic concerns about expanding use of the $25,000 operation.
Gastric-bypass surgery has become an increasingly popular response to the obesity epidemic. The surgery, which shrinks the stomach and sometimes reroutes the intestines, has been widely shown to provide long-term weight loss.
Last year, surgeons performed 177,600 gastric-bypass operations in the U.S., according to the American Society for Metabolic and Bariatric Surgery.
Until now, evidence that the lower weight resulting from the surgery actually saves lives has been scant.
The first of the studies, from Utah, involving gastric-bypass patients and a control group, found the surgery patients' mortality rate improved by 40%. The other study, from Sweden, followed overweight people who had different kinds of weight-loss operations. It found they had 29% improved mortality during the study against comparably overweight people who didn't have surgery.
The Journal's editorialist, George Bray, chief of the division of clinical obesity at Pennington Biomedical Research Center at Louisiana State University, said in an interview that the studies are the equivalent of "the statin trials that showed the drugs reduced death rates and not just cholesterol." Following those studies, cholesterol-fighting statins became a huge business for the pharmaceutical industry.
Dr. Bray said the studies -- which included people who had surgery at relatively low levels of obesity -- make it clear that the National Institutes of Health should reconsider guidelines that suggest the surgery as an option for patients whose body-mass indexes surpass 40. Normal BMIs range up to 25, and people with BMIs above 30 are considered obese. However, Dr. Bray said he isn't willing to come out in favor of a lower standard because, "You'll break the bank."
The Swedish Obese Subjects Study followed 2,010 patients from when they had the operation for as long as 16 years and compared them with a group of comparable subjects based on BMI, gender and other factors. The study found that the surgical patients after 10 years had kept off between 14% and 25% of their original weight, depending on whether they had older surgery types or the more modern gastric bypass.
In the Swedish study, 101 of those who had the surgery died in the study period; of those who didn't have the surgery, 129 died. Deaths from heart disease and cancer were both sharply lower in the group that received surgery.
The Utah study, led by Ted Adams of the University of Utah, compared 7,925 people who had gastric-bypass surgery after 1984 with a similar number of severely obese people culled from driver's license rolls. Those who received surgery had 213 deaths, compared with 321 for the control group. Surgery patients had 56% fewer deaths from cardiovascular events, 60% fewer from cancer and 92% fewer deaths from diabetes. However, people who had the surgery had 15 deaths from suicide compared with five suicides among the control group. The study didn't theorize about reasons for the higher suicide rate.
Write to William M. Bulkeley
Friday, May 25, 2007
Bariatric Surgery for Morbid Obesity
The New England Journal of Medicine
Volume 356 — May 24, 2007 — Number 21
Bariatric Surgery for Morbid Obesity
Eric J. DeMaria, M.D.
This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author's clinical recommendations.
LINK: http://content.nejm.org/cgi/content/short/356/21/2176?rss=1&query=current
Volume 356 — May 24, 2007 — Number 21
Bariatric Surgery for Morbid Obesity
Eric J. DeMaria, M.D.
This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author's clinical recommendations.
LINK: http://content.nejm.org/cgi/content/short/356/21/2176?rss=1&query=current
Subscribe to:
Posts (Atom)