Treating Diabetes in the Morbidly Obese by Laparoscopic Gastric Banding

Background: Remission of diabetes following Roux-en-Y gastric bypass has been postulated to occur partly by bypass of the foregut. Laparoscopic adjustable gastric banding (LAGB) also reduces food intake but does not bypass the foregut, and its effects on diabetes have yet to be elucidated. Methods: Patients with diabetes or a history of diabetes and >6 months follow-up after LAGB were studied. Follow-up was conducted separately by a surgeon with regard to weight loss and potential morbidity and by a physician with regard to diabetic control. Results: 14 patients had had gestational diabetes, and diabetes was controlled by diet in 25, oral hypoglycemics in 38 and insulin in 11 patients. Reduction in body mass index (BMI) and percentage of excess weight loss (%EWL) were similar in these 4 subgroups, with a median reduction in BMI of 11.7 kg/m2 and %EWL of 51.1% at 24 months. 26 of 38 patients controlled with oral hypoglycemic medication and 6 of 11 insulin-dependent diabetics had all medication stopped at a median of 6.5 months following LAGB. Univariate and multivariate analyses identified %EWL ≥ 30.6% at 6 months as the only significant predictor of remission of diabetes. Conclusion:Two-thirds of the diabetic patients have had remission of diabetes following LAGB. LAGB is an effective treatment for diabetes in obese patients.