University of California, San Diego, Veterans Affairs Medical Center, San Diego, CA, USA.
Postgrad Med. 2012 Nov;124(6):73-81. doi: 10.3810/pgm.2012.11.2590.
Laparoscopic adjustable gastric banding (LAGB) is an established bariatric surgical procedure that produces meaningful weight loss and improvements in patients with type 2 diabetes mellitus (T2DM) and a body mass index (BMI) ≥ 30 kg/m2. This study examined the effect of LAGB on T2DM status in severely obese patients with T2DM.
This was a 2-year interim analysis of patients with T2DM who required daily hypoglycemic medication at baseline (N = 89) in the 5-year, open-label, prospective, observational LAP-BAND AP® EXperience (APEX) trial. Type 2 diabetes mellitus status was classified as "remission," "improved," "stable," or "worse" based on physician- and patient-reported changes in T2DM control and changes in hypoglycemic medication use.
At baseline, 89 (22.5%) of 395 patients required daily hypoglycemic medication; 66 patients had data available after 2 years. Remission of T2DM occurred in 32 (48.5%) patients, improvement occurred in 31 (47.0%) patients, and no change occurred in 3 (4.5%) patients. Overall, 95.5% of patients experienced remission or improvement in T2DM status. Duration of T2DM in patients with remission or improvement after 2 years was 4.0 and 6.7 years, respectively (P = 0.082 between groups), and was associated with change in T2DM status (logistic regression, P = 0.069). Baseline BMI, change in BMI, and percent weight loss were not significantly different between the T2DM response groups. Percent excess weight loss was numerically, but not statistically significantly, greater in remitted (-56.1%) compared with the improved response (-42.9%) group (P = 0.134), and was correlated with change in T2DM status (logistic regression, P = 0.052). After 2 years, patients experienced remission or improvement of other obesity comorbidities. The rate of revisional surgery or explantation was 3.4%, and it was not significantly different between patients with and without T2DM (P = 0.687).
Shorter duration of T2DM and greater percent excess weight loss were associated with an increased likelihood of remission or improvement in T2DM status through LAGB after 2 years. Laparoscopic adjustable gastric banding is a potential adjunctive treatment for obese patients with T2DM.
腹腔镜可调节胃束带术（LAGB）是一种已确立的减肥手术方法，可使体重指数（BMI）≥30kg/m2 的 2 型糖尿病（T2DM）和超重患者显著减重并改善病情。本研究旨在探讨 LAGB 对伴有 T2DM 的严重肥胖患者 T2DM 状态的影响。
这是一项为期 5 年、开放标签、前瞻性、观察性 LAP-BAND AP® EXperience（APEX）试验中基线时需要每日服用降糖药物的 T2DM 患者（N=89）的 2 年中期分析。根据医生和患者报告的 T2DM 控制变化以及降糖药物使用变化，将 T2DM 状态分为“缓解”、“改善”、“稳定”或“恶化”。
基线时，395 例患者中有 89 例（22.5%）需要每日服用降糖药物；2 年后有 66 例患者的数据可用。32 例（48.5%）患者的 T2DM 缓解，31 例（47.0%）患者改善，3 例（4.5%）患者无变化。总体而言，95.5%的患者 T2DM 状态得到缓解或改善。缓解或改善后 2 年的 T2DM 患者的 T2DM 持续时间分别为 4.0 年和 6.7 年（组间 P=0.082），且与 T2DM 状态变化相关（逻辑回归，P=0.069）。缓解或改善后 2 年 T2DM 患者的 T2DM 缓解或改善前的 BMI、BMI 变化和体重减轻百分比无显著差异。体重减轻百分比与 T2DM 状态变化相关（逻辑回归，P=0.052）。2 年后，患者的其他肥胖合并症得到缓解或改善。翻修手术或取出率为 3.4%，T2DM 患者与非 T2DM 患者之间无显著差异（P=0.687）。
T2DM 持续时间较短和体重减轻百分比较大与 LAGB 治疗后 2 年内 T2DM 缓解或改善的可能性增加相关。腹腔镜可调节胃束带术可能是肥胖合并 T2DM 患者的一种辅助治疗方法。
