Gastric Banding as Effective as Medication in Slowing Prediabetes; Type 2 Diabetes

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By : Suvarna Sheth

A National Institutes of Health-supported study finds people with prediabetes or those with type 2 diabetes who weight loss surgery, had similar stabilization of their disease than if they were taking medication.

The study, known as BetaFat, enrolled 88 participants with mild to moderate obesity and either prediabetes or new-onset type 2 diabetes.

Half of the participants were randomly assigned to receive a gastric banding procedure, involving placement of a band around the upper part of the stomach to slow digestion.

The other participants received the drug metformin, the most common first-line medication for people with prediabetes and early type 2 diabetes.

The BetaFat study was conducted at the University of Southern California, Los Angeles, in collaboration with Kaiser Permanente Southern California.

After two years, people in the gastric banding group lost significantly more weight, an average of 23 pounds, compared to four pounds in the metformin group.

These results are part of the RISE study, a set of three clinical trials designed to find ways to reverse or slow the loss of insulin production and release in people at risk for type 2 diabetes.

While BetaFat compared results from surgical weight loss to medication, the two other RISE trials looked at the effects of a variety of medications in youth and adults.

“The three different RISE studies are all feasibility studies,” indicates Dr. Steven Kahn of the University of Washington and VA Puget Sound Healthcare System and chair of the RISE study consortium. “The findings are provocative and suggest further work is needed.”

The two treatment groups ended up with similar improvements in insulin sensitivity and relatively stable function of insulin-producing cells, with small improvements in blood glucose levels.

Kahn indicates that the diabetes prevention program showed that a lifestyle intervention with weight loss was more beneficial than metformin alone but in this instance, without additional follow up, one cannot be sure.

As regards to reduced incidence or slowed progression, “I would say are much the same thing as if one looked at the data at a single time point, slowing progression will reduce the incidence of new cases of diabetes,” Kahn says.

Kahn says the results underscore that, in adults, weight loss is a good approach to reduce the risk of developing diabetes.

NIH support for the study comes through NIDDK grants, with additional support from the National Center for Advancing Translational Sciences grant.

The Department of Veterans Affairs, Kaiser Permanente Southern California, and the American Diabetes Association also support the studies, with additional donations of supplies from Allergan Corporation, Apollo Endosurgery, Abbott Laboratories, and Novo Nordisk A/S.

A list of full disclosures is published in Diabetes Care

Results were also presented during the European Association for the Study of Diabetes Annual Meeting in Berlin.

Sources:

  1. “Gastric banding as effective as metformin in slowing progression of prediabetes, type 2 diabetes.” October 3, 2018. National Institutes of Health. Retrieved: https://www.nih.gov/news-events/news-releases/gastric-banding-effective-metformin-slowing-progression-prediabetes-type-2-diabetes.
  2. “Impact of Gastric Banding Versus Metformin on β-Cell Function in Adults With Impaired Glucose Tolerance or Mild Type 2 Diabetes.”Anny H. XiangEnrique TrigoMayra MartinezNamir KatkhoudaElizabeth BealeXinhui WangJun WuTing ChowCortney MontgomeryKrishna S. NayakFadi HendeeThomas A. Buchanan and for the RISE Consortium.