Multidisciplinary diabetes care with and without bariatric surgery in overweight people: a randomised controlled trial

John Wentworth, Julie Marie Playfair, Cheryl Laurie, Matthew E Ritchie, Wendy Ann Brown, Paul Robert Burton, Jonathan Edward Shaw, Paul Edmond O'Brien

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66 Citations (Scopus)

Abstract

Background: Bariatric surgery improves glycaemia in obese people with type 2 diabetes, but its effects are uncertain in overweight people with this disease. We aimed to identify whether laparoscopic adjustable gastric band surgery can improve glucose control in people with type 2 diabetes who were overweight but not obese. Methods: We did an open-label, parallel-group, randomised controlled trial between Nov 1, 2009, and June 30, 2013, at one centre in Melbourne, Australia. Patients aged 18-65 years with type 2 diabetes and a BMI between 25 and 30 kg/m2 were randomly assigned (1:1), by computer-generated random sequence, to receive either multidisciplinary diabetes care plus laparoscopic adjustable gastric band surgery or multidisciplinary diabetes care alone. The primary outcome was diabetes remission 2 years after randomisation, defined as glucose concentrations of less than 7?0 mmol/L when fasting and less than 11?1 mmol/L 2 h after 75 g oral glucose, at least two days after stopping glucose-lowering drugs. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000286246. Findings: 51 patients were randomised to the multidisciplinary care plus gastric band group (n=25) or the multidisciplinary care only group (n=26), of whom 23 participants and 25 participants, respectively, completed follow-up to 2 years. 12 (52 ) participants in the multidisciplinary care plus gastric band group and two (8 ) participants in the multidisciplinary care only group achieved diabetes remission (difference in proportions 0?44, 95 CI 0?17-0?71; p=0?0012). One (4 ) participant in the gastric band group needed revisional surgery and four others (17 ) had a total of five episodes of food intolerance due to excessive adjustment of the band. Interpretation: When added to multidisciplinary care, laparoscopic adjustable gastric band surgery for overweight people with type 2 diabetes improves glycaemic control with an acceptable adverse event profile. Laparoscopic adjustable gastric band surgery is a reasonable treatment option for this population. Funding: Monash University Centre for Obesity Research and Education and Allergan.
Original languageEnglish
Pages (from-to)545 - 552
Number of pages8
JournalThe Lancet Diabetes and Endocrinology
Volume2
Issue number7
DOIs
Publication statusPublished - 2014

Cite this

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title = "Multidisciplinary diabetes care with and without bariatric surgery in overweight people: a randomised controlled trial",
abstract = "Background: Bariatric surgery improves glycaemia in obese people with type 2 diabetes, but its effects are uncertain in overweight people with this disease. We aimed to identify whether laparoscopic adjustable gastric band surgery can improve glucose control in people with type 2 diabetes who were overweight but not obese. Methods: We did an open-label, parallel-group, randomised controlled trial between Nov 1, 2009, and June 30, 2013, at one centre in Melbourne, Australia. Patients aged 18-65 years with type 2 diabetes and a BMI between 25 and 30 kg/m2 were randomly assigned (1:1), by computer-generated random sequence, to receive either multidisciplinary diabetes care plus laparoscopic adjustable gastric band surgery or multidisciplinary diabetes care alone. The primary outcome was diabetes remission 2 years after randomisation, defined as glucose concentrations of less than 7?0 mmol/L when fasting and less than 11?1 mmol/L 2 h after 75 g oral glucose, at least two days after stopping glucose-lowering drugs. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000286246. Findings: 51 patients were randomised to the multidisciplinary care plus gastric band group (n=25) or the multidisciplinary care only group (n=26), of whom 23 participants and 25 participants, respectively, completed follow-up to 2 years. 12 (52 ) participants in the multidisciplinary care plus gastric band group and two (8 ) participants in the multidisciplinary care only group achieved diabetes remission (difference in proportions 0?44, 95 CI 0?17-0?71; p=0?0012). One (4 ) participant in the gastric band group needed revisional surgery and four others (17 ) had a total of five episodes of food intolerance due to excessive adjustment of the band. Interpretation: When added to multidisciplinary care, laparoscopic adjustable gastric band surgery for overweight people with type 2 diabetes improves glycaemic control with an acceptable adverse event profile. Laparoscopic adjustable gastric band surgery is a reasonable treatment option for this population. Funding: Monash University Centre for Obesity Research and Education and Allergan.",
author = "John Wentworth and Playfair, {Julie Marie} and Cheryl Laurie and Ritchie, {Matthew E} and Brown, {Wendy Ann} and Burton, {Paul Robert} and Shaw, {Jonathan Edward} and O'Brien, {Paul Edmond}",
year = "2014",
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volume = "2",
pages = "545 -- 552",
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Multidisciplinary diabetes care with and without bariatric surgery in overweight people: a randomised controlled trial. / Wentworth, John; Playfair, Julie Marie; Laurie, Cheryl; Ritchie, Matthew E; Brown, Wendy Ann; Burton, Paul Robert; Shaw, Jonathan Edward; O'Brien, Paul Edmond.

In: The Lancet Diabetes and Endocrinology, Vol. 2, No. 7, 2014, p. 545 - 552.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Multidisciplinary diabetes care with and without bariatric surgery in overweight people: a randomised controlled trial

AU - Wentworth, John

AU - Playfair, Julie Marie

AU - Laurie, Cheryl

AU - Ritchie, Matthew E

AU - Brown, Wendy Ann

AU - Burton, Paul Robert

AU - Shaw, Jonathan Edward

AU - O'Brien, Paul Edmond

PY - 2014

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N2 - Background: Bariatric surgery improves glycaemia in obese people with type 2 diabetes, but its effects are uncertain in overweight people with this disease. We aimed to identify whether laparoscopic adjustable gastric band surgery can improve glucose control in people with type 2 diabetes who were overweight but not obese. Methods: We did an open-label, parallel-group, randomised controlled trial between Nov 1, 2009, and June 30, 2013, at one centre in Melbourne, Australia. Patients aged 18-65 years with type 2 diabetes and a BMI between 25 and 30 kg/m2 were randomly assigned (1:1), by computer-generated random sequence, to receive either multidisciplinary diabetes care plus laparoscopic adjustable gastric band surgery or multidisciplinary diabetes care alone. The primary outcome was diabetes remission 2 years after randomisation, defined as glucose concentrations of less than 7?0 mmol/L when fasting and less than 11?1 mmol/L 2 h after 75 g oral glucose, at least two days after stopping glucose-lowering drugs. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000286246. Findings: 51 patients were randomised to the multidisciplinary care plus gastric band group (n=25) or the multidisciplinary care only group (n=26), of whom 23 participants and 25 participants, respectively, completed follow-up to 2 years. 12 (52 ) participants in the multidisciplinary care plus gastric band group and two (8 ) participants in the multidisciplinary care only group achieved diabetes remission (difference in proportions 0?44, 95 CI 0?17-0?71; p=0?0012). One (4 ) participant in the gastric band group needed revisional surgery and four others (17 ) had a total of five episodes of food intolerance due to excessive adjustment of the band. Interpretation: When added to multidisciplinary care, laparoscopic adjustable gastric band surgery for overweight people with type 2 diabetes improves glycaemic control with an acceptable adverse event profile. Laparoscopic adjustable gastric band surgery is a reasonable treatment option for this population. Funding: Monash University Centre for Obesity Research and Education and Allergan.

AB - Background: Bariatric surgery improves glycaemia in obese people with type 2 diabetes, but its effects are uncertain in overweight people with this disease. We aimed to identify whether laparoscopic adjustable gastric band surgery can improve glucose control in people with type 2 diabetes who were overweight but not obese. Methods: We did an open-label, parallel-group, randomised controlled trial between Nov 1, 2009, and June 30, 2013, at one centre in Melbourne, Australia. Patients aged 18-65 years with type 2 diabetes and a BMI between 25 and 30 kg/m2 were randomly assigned (1:1), by computer-generated random sequence, to receive either multidisciplinary diabetes care plus laparoscopic adjustable gastric band surgery or multidisciplinary diabetes care alone. The primary outcome was diabetes remission 2 years after randomisation, defined as glucose concentrations of less than 7?0 mmol/L when fasting and less than 11?1 mmol/L 2 h after 75 g oral glucose, at least two days after stopping glucose-lowering drugs. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000286246. Findings: 51 patients were randomised to the multidisciplinary care plus gastric band group (n=25) or the multidisciplinary care only group (n=26), of whom 23 participants and 25 participants, respectively, completed follow-up to 2 years. 12 (52 ) participants in the multidisciplinary care plus gastric band group and two (8 ) participants in the multidisciplinary care only group achieved diabetes remission (difference in proportions 0?44, 95 CI 0?17-0?71; p=0?0012). One (4 ) participant in the gastric band group needed revisional surgery and four others (17 ) had a total of five episodes of food intolerance due to excessive adjustment of the band. Interpretation: When added to multidisciplinary care, laparoscopic adjustable gastric band surgery for overweight people with type 2 diabetes improves glycaemic control with an acceptable adverse event profile. Laparoscopic adjustable gastric band surgery is a reasonable treatment option for this population. Funding: Monash University Centre for Obesity Research and Education and Allergan.

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