Anny H Xiang1, Enrique Trigo2, Mayra Martinez3, Namir Katkhouda4, Elizabeth Beale2, Xinhui Wang3, Jun Wu3, Ting Chow3, Cortney Montgomery4, Krishna S Nayak5, Fadi Hendee6, Thomas A Buchanan. 1. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA buchanan@usc.edu anny.h.xiang@kp.org. 2. Division of Endocrinology and Diabetes, Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA. 3. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA. 4. Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, CA. 5. Ming Hsieh Department of Electrical Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA. 6. Division of Endocrinology, Clinical Nutrition and Metabolism, Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV.
Abstract
OBJECTIVE: Type 2 diabetes (T2D) results from progressive loss of β-cell function. The BetaFat study compared gastric banding and metformin for their impact on β-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 β-cell function and stabilize or improve glycemia over a 2-year period in moderately obese adults with IGT or recently diagnosed, mild T2D.
RCT Entities:
OBJECTIVE:Type 2 diabetes (T2D) results from progressive loss of β-cell function. The BetaFat study compared gastric banding and metformin for their impact on β-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 β-cell function and stabilize or improve glycemia over a 2-year period in moderately obese adults with IGT or recently diagnosed, mild T2D.
Authors: Abbas E Kitabchi; Marinella Temprosa; William C Knowler; Steven E Kahn; Sarah E Fowler; Steven M Haffner; Reuben Andres; Christopher Saudek; Sharon L Edelstein; Richard Arakaki; Mary Beth Murphy; Harry Shamoon Journal: Diabetes Date: 2005-08 Impact factor: 9.461
Authors: Tamara S Hannon; Steven E Kahn; Kristina M Utzschneider; Thomas A Buchanan; Kristen J Nadeau; Philip S Zeitler; David A Ehrmann; Silva A Arslanian; Sonia Caprio; Sharon L Edelstein; Peter J Savage; Kieren J Mather Journal: Diabetes Obes Metab Date: 2017-06-22 Impact factor: 6.577
Authors: Ralph A DeFronzo; Devjit Tripathy; Dawn C Schwenke; MaryAnn Banerji; George A Bray; Thomas A Buchanan; Stephen C Clement; Robert R Henry; Howard N Hodis; Abbas E Kitabchi; Wendy J Mack; Sunder Mudaliar; Robert E Ratner; Ken Williams; Frankie B Stentz; Nicolas Musi; Peter D Reaven Journal: N Engl J Med Date: 2011-03-24 Impact factor: 91.245
Authors: X R Pan; G W Li; Y H Hu; J X Wang; W Y Yang; Z X An; Z X Hu; J Lin; J Z Xiao; H B Cao; P A Liu; X G Jiang; Y Y Jiang; J P Wang; H Zheng; H Zhang; P H Bennett; B V Howard Journal: Diabetes Care Date: 1997-04 Impact factor: 19.112
Authors: Kristina M Utzschneider; Ronald L Prigeon; Mirjam V Faulenbach; Jenny Tong; Darcy B Carr; Edward J Boyko; Donna L Leonetti; Marguerite J McNeely; Wilfred Y Fujimoto; Steven E Kahn Journal: Diabetes Care Date: 2008-10-28 Impact factor: 19.112
Authors: Kieren J Mather; Ashley H Tjaden; Adam Hoehn; Kristen J Nadeau; Thomas A Buchanan; Steven E Kahn; Silva A Arslanian; Sonia Caprio; Karen M Atkinson; Melanie Cree-Green; Kristina M Utzschneider; Sharon L Edelstein Journal: Am J Physiol Endocrinol Metab Date: 2021-03-01 Impact factor: 4.310
Authors: Anny H Xiang; Mayra P Martinez; Enrique Trigo; Kristina M Utzschneider; Melanie Cree-Green; Silva A Arslanian; David A Ehrmann; Sonia Caprio; Passant H I H Mohamed; Darryl H Hwang; Namir Katkhouda; Krishna S Nayak; Thomas A Buchanan Journal: Obesity (Silver Spring) Date: 2021-05-26 Impact factor: 9.298
Authors: Amy E Rothberg; William H Herman; Chunyi Wu; Heidi B IglayReger; Jeffrey F Horowitz; Charles F Burant; Andrzej T Galecki; Jeffrey B Halter Journal: J Clin Endocrinol Metab Date: 2020-04-01 Impact factor: 5.958
Authors: Steven E Kahn; Sharon L Edelstein; Silva A Arslanian; Elena Barengolts; Sonia Caprio; David A Ehrmann; Tamara S Hannon; Santica Marcovina; Kieren J Mather; Kristen J Nadeau; Kristina M Utzschneider; Anny H Xiang; Thomas A Buchanan Journal: Diabetes Care Date: 2021-06-16 Impact factor: 17.152