John M Wentworth1,2, Julie Playfair3, Cheryl Laurie3, Wendy A Brown3, Paul Burton3, Jonathan E Shaw4, Paul E O'Brien3. 1. Centre for Obesity Research and Education (CORE), Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. wentworth@wehi.edu.au. 2. Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Melbourne, Australia. wentworth@wehi.edu.au. 3. Centre for Obesity Research and Education (CORE), Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, Victoria, 3004, Australia. 4. Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
Abstract
BACKGROUND: We aimed to determine the effects of laparoscopic adjustable gastric band (LAGB) on beta-cell function in overweight people with type 2 diabetes and to assess the relationship between baseline beta-cell function and glycemic outcomes. METHODS: We studied 44 overweight but not obese people with type 2 diabetes who participated in a randomized trial whose primary outcome was the rate of diabetes remission after 2 years of multidisciplinary diabetes care (MDC group) or multidisciplinary care combined with LAGB. Dynamic beta-cell function was assessed by intravenous glucose challenge, and basal beta-cell function (HOMA-B) and insulin sensitivity (HOMA-S) were determined using the homeostatic model. RESULTS:Twelve LAGB participants and two MDC participants were in diabetes remission at 2 years. HOMA-S and the C-peptide response to intravenous glucose increased significantly in LAGB but not in MDC participants. The insulin response to glucose did not change in LAGB participants, whereas their fasting C-peptide/insulin ratio increased. Baseline measures of beta-cell function correlated with diabetes remission but not with reduction in HbA1c following LAGB. CONCLUSIONS: In overweight people with diabetes, LAGB improves endogenous beta-cell function after 2 years. Baseline beta-cell function correlated with diabetes remission, but not with HbA1c change following LAGB.
RCT Entities:
BACKGROUND: We aimed to determine the effects of laparoscopic adjustable gastric band (LAGB) on beta-cell function in overweight people with type 2 diabetes and to assess the relationship between baseline beta-cell function and glycemic outcomes. METHODS: We studied 44 overweight but not obesepeople with type 2 diabetes who participated in a randomized trial whose primary outcome was the rate of diabetes remission after 2 years of multidisciplinary diabetes care (MDC group) or multidisciplinary care combined with LAGB. Dynamic beta-cell function was assessed by intravenous glucose challenge, and basal beta-cell function (HOMA-B) and insulin sensitivity (HOMA-S) were determined using the homeostatic model. RESULTS: Twelve LAGB participants and two MDC participants were in diabetes remission at 2 years. HOMA-S and the C-peptide response to intravenous glucose increased significantly in LAGB but not in MDC participants. The insulin response to glucose did not change in LAGB participants, whereas their fasting C-peptide/insulin ratio increased. Baseline measures of beta-cell function correlated with diabetes remission but not with reduction in HbA1c following LAGB. CONCLUSIONS: In overweight people with diabetes, LAGB improves endogenous beta-cell function after 2 years. Baseline beta-cell function correlated with diabetes remission, but not with HbA1c change following LAGB.
Entities:
Keywords:
Bariatric surgery; Beta-cell function; Diabetes remission; First-phase insulin release; IVGTT; Type 2 diabetes; Weight loss
Authors: Lars Sjöström; Markku Peltonen; Peter Jacobson; Sofie Ahlin; Johanna Andersson-Assarsson; Åsa Anveden; Claude Bouchard; Björn Carlsson; Kristjan Karason; Hans Lönroth; Ingmar Näslund; Elisabeth Sjöström; Magdalena Taube; Hans Wedel; Per-Arne Svensson; Kajsa Sjöholm; Lena M S Carlsson Journal: JAMA Date: 2014-06-11 Impact factor: 56.272