The remission rates of type 2 diabetes after laparoscopic adjustable gastric banding are influenced by the duration of disease, according to interim results from the APEX study….
Ted Okerson, MD, assistant clinical professor of medicine at the University of California at Irvine, and an employee of Allergan, which makes the gastric band used in the study stated that, “We know that if we intervene early, when there are still functional beta cells, we can expect more chance for remission.” APEX is a 5-year ongoing study of 508 severely or morbidly obese patients from 50 centers in the United States who underwent laparoscopic adjustable gastric banding using the company’s LAP-BAND AP system.
Previously published 48-week interim results for 323 subjects showed a mean percentage of excess weight loss of 46% and a reduction in body mass index (BMI) of 8.4 kg/m² (Surg Obes Relat Dis. Published online September 19, 2011).
Excess weight is defined as the amount of weight over a BMI of 25 kg/m², explained Dr. Okerson.
A new interim subanalysis of 66 study subjects who enrolled in APEX with preexisting type 2 diabetes has shown that diabetic remission is common in this subgroup, but it is influenced by the duration of disease.
Two years after surgery, almost half of the diabetic subjects (48.5%) showed complete remission of their diabetes, “defined as elimination of all medications for type 2 diabetes,” reported Dr. Okerson.
Another 47% of subjects showed improvement in their diabetes, defined as “a reduction in medication and/or an improvement in overall glycemic control.”
Disease duration was significantly different between the remission and improved groups, he said.
“When we look at the duration of diabetes in the remission group, it averaged about 4.0 years, whereas those who had improvement averaged a mean of 6.7 years; this difference was statistically significant (P = .03). The 2 patients who had no change had a mean duration of 8.5 years.”
In the overall study population, weight loss was substantial for all patients, but it was most pronounced in patients who reported diabetic remission. Although baseline BMI was similar in patients regardless of remission, improvement, or no change in diabetes (43.7, 44.4, and 41.0 kg/m², respectively), the reduction in BMI at 2 years was slightly greater in the remission group (10.1 kg/m²) than in the improved and no change groups (8.4 and 8.0 kg/m²). Similarly, the percent reduction in weight was a little more in the remission group (22.8%) than in the improved (18.5%) and no change groups (18.7%).
However, it was only the percent of excess weight loss that was statistically different between the remission and the improved groups (55.7% vs 42.9%).
The findings underscore the fact that the advantages of bariatric surgery go beyond weight loss alone, said Bill Law, MD, moderator of the session and a physician at Endocrinology Consultants of East Tennessee in Knoxville.
“All of us have a number of former patients who no longer need us because they had their bariatric surgery and are now a mere shadow of their former selves — their medication list has shrunk (they’re on vitamins), their blood pressure is normal, their cholesterol is normal,” he said in an interview with Medscape Medical News.
Dr. Law noted that, “Many of us now consider bariatric surgery, in whatever form, to be mainstream therapy for the long-term management of diabetes for the very simple reason that we don’t have other effective therapies that result in the magnitude of weight reduction that is sadly necessary in many of our patients.”
Presented at the American Association of Clinical Endocrinologist (AACE) May 24, 2012, Abstract 707