|
|
|
|
                 
|
 |
Weight loss following Laparoscopic Adjustable Gastric Band surgery produces sustained improvements in fasting plasma Glucose and indirect measures of Insulin Sensitivity Authors: John B Dixon and Paul E O'Brien Institution: Department of Surgery, Monash University, Melbourne. Australia
We have prospectively followed 800 (120 M, 680 F) consecutive subjects having LAGB gastric restrictive surgery with yearly fp glucose, insulin and HbA1c for up to 4-years. Mean pre-operative age, weight and BMI were 40.9 ± 10 years, 124 ± 29 kg and 44.9 ± 7.5 kg/m2 respectively. Four percent of patients are currently lost to follow-up. The group was examined as a whole and stratified into diabetic (n=95), impaired fasting glucose (n=85) and normal fasting glucose (n=620). The loge transformed insulin glucose product was calculated as an indirect index of insulin resistance (IRI). Mean percentage of excess weight loss was 44.5 +/- 20%, 50.3 ± 20%, 49.3 ± 23% and 55.8 ± 21% at 1,2,3 and 4-years after band placement respectively.
Insulin levels fell substantially at 1-year in those with normal and impaired fasting glucose, and remained low (p<0.001) but in those with type 2 diabetes there was no significant change in fp insulin over 4 years. A sustained fall in IRI was seen in all groups of patients. During follow-up no patients with normal or impaired fasting glucose pre-operatively have developed type 2 diabetes. Sustained weight loss produces sustained reductions in fp glucose and insulin in non-diabetic subjects reducing insulin resistance and the risk of developing type 2 diabetes. It also provides a sustained reduction in insulin resistance and greatly improved glycemic control or provides disease remission in those with type 2 diabetes. LAGB weight loss surgery is very effective for treating and preventing type 2 diabetes in severely obese patients.
The Centre For Bariatric Surgery - 23 The Avenue, Windsor, AUSTRALIA |
 |
 |
|
|
All site content copyright Malcolm
Bywaters and WorldWyldWeb.com 2003 |
||
Weight loss is possibly the best therapy
for the prevention and treatment of type 2 diabetes. Our aim was to
examine the effect of laparoscopic adjustable gastric band (LAGB)
surgically induced weight loss on fasting plasma (fp) glucose, insulin and
HbA1c in severely obese subjects. 
Favorable changes in fp glucose, HbA1c,
fp insulin and IRI are seen at 1-year (p<0.001 for all). All improvements
are maintained out to 4 years when weight was stable. For subjects with
diabetes median ± inter-quartile range HbA1c
levels were 7.9 +/- 3% pre-operatively and 5.9 ±
1.1 %, 5.7 ± 1.7%, 5.7 ±
1.2% and 6.0 ± 1.3% at 1-4 years respectively.
