Gastric Banding Now Suggested for Non-Obese Type 2s

| Dec 12, 2013

We've suggested over the past few years that Diabetes Health readers keep an eye on the move to make gastric banding a therapy for non-obese type 2 patients. The procedure works by placing a band around the upper part of the study to restrict food intake and produce a feeling of satiety with less food.

The result for many type 2s has often been the total cessation of diabetes symptoms and long-lasting remissions that some might even call a cure--although medical people are reluctant to use that word.

Until now, those results have been limited to obese type 2s, people with a body mass index of 35 or above. But as evidence accumulates that gastric banding often has dramatic effects on type 2 diabetes, the surgeons who do the procedure are increasingly calling for it to be available to type 2s who are overweight, but fall below the 35 BMI threshold.

The latest support for their push to relax the requirements for gastric banding eligibility comes from an Australian study presented just days ago in Melbourne, Australia, at the International Diabetes Federation World Congress.

The two-year study tracked 51 overweight type 2s who had been diagnosed within five or fewer years. Patients received either gastric banding or standard diabetes treatment that included regular interaction with a doctor, diabetes educator, and dietitian.

Type 2s with gastric banding achieved what researchers defined success: glucose readings, after going off medications, of 126 mg/dl fasting and 200 mg/dl two hours after administration of a "oral glucose challenge" designed to mimic the aftereffects of a meal.

Gastric-banded patients, whose BMI numbers ranged from 25 to 30, lost an average of 24 lbs. (11 kg) versus 2.3 lbs. in the study group receiving conventional care. The difference in remission rates between the two groups was dramatic: 52 percent of the patients with gastric banding were considered in remission versus 8 percent of patients in the standard care group.

Some patients considered to be in remission continued taking metformin, but none in the gastric banding group continued taking other medications, such as sulfonylureas, exenatide, and insulin.

The Australian researchers, led by Dr. John Wentworth, an endocrinologist and research fellow at the Monash University Centre for Obesity Research and Education in Melbourne, concluded that gastric bypass "was a reasonable option" for helping overweight type 2s achieve weight loss, lower their overall blood glucose levels, and require much less or no medications.

However, Wentworth cautioned that the study's results only covered type 2s who has been formally diagnosed with diabetes for five or fewer years. Effects of the surgery on overweight type 2s who have had the disease for more than five years are not known.

Watch for more pressure to come from surgeons who perform gastric banding to move the goalposts, so to speak, to allow type 2 patients with lower BMI numbers to undergo the procedure. The big question will be whether insurance companies and HMOs will allow gastric banding to become a type 2 therapy they are willing to cover as routine.


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Categories: Gastric Banding, Remission, Type 2

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