Medium-term outcomes of patients with insulin-dependent diabetes after laparoscopic adjustable gastric banding.

Background: Bariatric surgery is effective in the control of type 2 diabetes mellitus. Laparoscopic adjustable gastric banding is a popular form of bariatric surgery, but very limited data are available on its long-term effect on type 2 diabetes mellitus. The present study examined the effect of gastric banding on a consecutive cohort of unselected patients with insulin-dependent diabetes mellitus at a teaching hospital in Birmingham, United Kingdom.

Methods: From April 2003 to December 2008, 200 patients with diabetes underwent laparoscopic adjustable gastric banding at our unit. All those with insulin-dependent diabetes and ≥1 year of follow-up were included in the present analysis. Data collection included the body mass index, weight, blood pressure, glycosylated hemoglobin, fasting glucose, total cholesterol, triglycerides, and medication dose preoperatively and 1, 2, and 3 years postoperatively.

Results: Preoperatively, 69 patients were taking insulin, with a mean daily preoperative dose of 132.3 U (range 15-500). At 1 year, 27 of these patients had discontinued using insulin (34.8%). At 2 years, 34 patients had discontinued using insulin (54.8% of the patients taking insulin preoperatively and who had also completed 2 yr of follow-up). At 3 years, 40 patients had discontinued using insulin (80% of patients who were taking insulin preoperatively and who had also completed 3 yr of follow-up). These changes were accompanied by an improvement in glycosylated hemoglobin, fasting glucose, total serum cholesterol, triglycerides, and mean arterial pressures.

Conclusion: Laparoscopic gastric banding can be considered a powerful treatment option in the management of obese patients with insulin-dependent diabetes and becomes increasingly effective with time ≤3 years after surgery.