Gastric Banding and Metformin Have Similar Effects on β-cell Function in Some Type 2 Diabetes Patients

In a new study, gastric banding surgery was equitable to metformin in preserving β-cell function in moderately obese patients with impaired glucose tolerance (IGT) or recently diagnosed obese type 2 diabetes (T2D) patients. 

The study included 88 people aged between 21 and 65 years old with a body mass index (BMI) between 30 and 40 kg/m2 with IGT or diabetes known for less than one year. Patients were randomly assigned to gastric binding or metformin for two years. The gastric band group received adjustments every two months for the first year and then every three months for the second year based on symptoms and weight change. At baseline, one year and two years, patients received hyperglycemic clamps (11.1 mmol/L) and arginine injection (> 25 mmol/L). 

After two years, the gastric banding group lost significantly more weight than the metformin group (10.7 kg vs 1.7 kg; P < 0.01). The band group also had greater incidence of insulin sensitivity (45%) than the metformin cohort (25%) (= 0.30 between groups). Both groups saw a slight decrease in steady-state C-peptide when adjusted for insulin sensitivity (= 0.34 between groups). The metformin group saw a significant decrease in argenine at maximum glycemic potentiation adjusted for insulin sensitivity (= 0.002) but not the band group (P = 0.25 between groups). The band group saw drops in HbA1c at one and two years (< 0.004) but the metformin only saw a decrease at one year (< 0.01) (P > 0.14 between groups). At two years, normoglycemia was present in 22% of the band group and 15% of the metformin group (= 0.66 between groups). 

The study results were published in Diabetes Care. 

“Both interventions resulted in about 50% improvements in insulin sensitivity at 1 year, which was attenuated at 2 years,” said study author Thomas Buchanan, MD, of the University of Southern California, Los Angeles, while presenting at the annual meeting of the European Association for the Study of Diabetes. 

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Sources: Diabetes CareClinical Endocrinology News