PHILADELPHIA – The likelihood for improvement or remission of type 2 diabetes after gastric banding appears to be predicted by disease duration and potentially the amount of weight loss. According to Ted Okerson, MD, MAS, FACP, these results suggest that early surgical intervention could be considered in obese patients with type 2 diabetes.
“Lifestyle changes are difficult to sustain in the long-term,” Okerson, of the University of California, said during his presentation of results of the LAP-BAND AP Experience (APEX) trial. “The best opportunity for remission of diabetes — whether we use surgery or whether we use intensive lifestyle — is to really intervene early and aggressively while there’s still remaining beta cell function.”
APEX, an ongoing, 5-year, prospective, multicenter, open-label, observational study, was designed to assess the safety and efficacy of the LAP-BAND AP system and changes in the comorbidities of obesity. This presentation examined the changes in type 2 diabetes 2 years after laparoscopic adjustable gastric banding.
“Improvement” in disease was defined as reduction in hypoglycemic medication, and “remission” was defined as elimination of hypoglycemic medication with the treating physician reporting disease remission.
At 2 years, 66 of 89 patients with type 2 diabetes at baseline had sufficient data to assess disease status. Remission occurred in 48.5% of patients and improvement in 47%; 4.5% of patients experienced no change in type 2 diabetes status. Patients who achieved remission or improvement had an average duration of disease of 4 and 6.7 years, respectively, compared with those who did not experience a change in disease status, whose average disease duration was 8.9 years.
However, all groups achieved weight loss. Changes in BMI and percent weight loss were –10.1/–22.8% for those in the remission group; –8.4/–18.5% in the improvement group; and –8.0/–18.7% in the no-change group.
In addition, percent excess weight loss after 2 years was significantly higher in the remission group (–55.7%) compared with the improvement group (42.9%; P=.03). Percent excess weight loss correlated with change in type 2 diabetes status, according to Okerson.
“We should realize that even with bariatric procedures, even among those who achieve 20% to 30% weight loss, the factors that predict remission of type 2 diabetes are duration of diabetes, as we showed in our study; the severity of the disease; and how much weight they lost or regained.” – by Stacey L. Fisher
Disclosure: Dr. Okerson is employed by Allergan, Inc.