Impact of Gastric Banding Versus Metformin on ß-Cell Function in Adults With Impaired Glucose Tolerance or Mild Type 2 Diabetes.

OBJECTIVE: Type 2 diabetes (T2D) results from progressive loss of ß-cell function. The BetaFat study compared gastric banding and metformin for their impact on ß-cell function in adults with moderate obesity and impaired glucose tolerance (IGT) or recently diagnosed, mild T2D. RESEARCH DESIGN AND METHODS: Eighty-eight people aged 21-65 years, BMI 30-40 kg/m2, with IGT or diabetes known for <1 year, were randomized to gastric banding or metformin for 2 years. Hyperglycemic clamps (11.1 mmol/L) followed by arginine injection at maximally potentiating glycemia (>25 mmol/L) were performed at baseline, 12 months, and 24 months to measure steady-state C-peptide (SSCP) and acute C-peptide response to arginine at maximum glycemic potentiation (ACPRmax) and insulin sensitivity (M/I). RESULTS: At 24 months, the band group lost 10.7 kg; the metformin group lost 1.7 kg (P < 0.01). Insulin sensitivity increased 45% in the band group and 25% in the metformin group (P = 0.30 between groups). SSCP adjusted for insulin sensitivity fell slightly but not significantly in each group (P = 0.34 between groups). ACPRmax adjusted for insulin sensitivity fell significantly in the metformin group (P = 0.002) but not in the band group (P = 0.25 between groups). HbA1c fell at 12 and 24 months in the band group (P < 0.004) but only at 12 months (P < 0.01) in the metformin group (P > 0.14 between groups). Normoglycemia was present in 22% and 15% of band and metformin groups, respectively, at 24 months (P = 0.66 between groups). CONCLUSIONS: Gastric banding and metformin had similar effects to preserve ß-cell function and stabilize or improve glycemia over a 2-year period in moderately obese adults with IGT or recently diagnosed, mild T2D.

Three-year weight outcomes from a bariatric surgery registry in a large integrated healthcare system.

BACKGROUND: A registry was created for patients having procedures for weight loss from 2004 to the present time at a large integrated healthcare system. The objective of this study was to compare findings to the literature and national quality monitoring databases and present 3-year weight loss outcomes. METHODS: Patients are passively enrolled in the registry with the following characteristics: a bariatric procedure for weight loss after January 1, 2004 and actively enrolled in the health plan at the time of surgery. RESULTS: Compared to national surgical quality databases, the registry (n = 20,296) has a similar proportion of Roux-en-Y gastric bypass (RYGB; 58%), more vertical sleeve gastrectomy (SG; 40%), fewer banding (2%) procedures, more Hispanic patients (35%), and higher rates of 1 year follow-up (78%). RYGB patients lost more weight at every time point up to 3 years after surgery compared with SG patients (P<.001). Non-Hispanic white RYGB patients had a higher percent excess weight loss than non-Hispanic black (P<.001) and Hispanic (P<.001) RYGB patients. There were no differences between SG racial/ethnic groups in percent excess weight loss throughout the 3-year follow-up period. CONCLUSION: We are one of the first groups to publish comparison weight outcomes for RYGB and SG in a diverse patient population, showing that the responses to RYGB and not SG vary by race/ethnicity.

What do I do with my morbidly obese patient? A detailed case study of bariatric surgery in kaiser permanente southern california.

Unfortunately, many of the traditional methods for weight loss, such as dietary restriction, exercise, meal replacement, psychosocial and behavioral interventions, and medications, have limited effectiveness in long-term weight maintenance and regulation of chronic diseases such as type 2 diabetes. This has led to the development of surgical approaches to weight loss, generally referred to as bariatric surgery. Most bariatric surgery studies have shown excellent weight-loss rates for up to two years after surgery, with patients losing an average of 61 % of their excess weight (losing 100% of excess weight would return patients to their ideal weight). There is also some evidence that most patients maintain some level of weight loss for up to ten years after surgery. The purpose of this article is to provide primary care physicians and other clinicians with some background regarding bariatric surgical procedures and their risks and benefits. We also summarize the bariatric surgery process at Kaiser Permanente Southern California (KPSC), and then provide a detailed case study as an example of how KPSC screens patients referred for surgery, prepares them for the surgery, and cares for them once they have undergone surgery.