Clin Nutr Res.  2017 Jul;6(3):206-214. 10.7762/cnr.2017.6.3.206.

Antidiabetic Effects of Gastric Banding Surgery in Morbidly Obese Patients with Type 2 Diabetes Mellitus

• Kim YJ
• Choi HN
• Lee HC
• Yim JE

• KMID: 2385625
• DOI: http://doi.org/10.7762/cnr.2017.6.3.206

Abstract

This study was performed to investigate the effect of gastric banding surgery on the improvement of glycated hemoglobin (HbA(1c)) of morbidly obese (MO) patients with type 2 diabetes mellitus (T2DM) with the consideration that obesity was associated with insulin resistance and T2DM. We retrospectively reviewed the medical records of 38 MO with T2DM patients and 50 MO patients. Pre-surgery and post-surgery data were analyzed a year later. The medical data from these patients, including sex, age, height, weight, body composition, HbA(1c), triglyceride, total cholesterol, aspartate transaminase (AST), and alanine transaminase (ALT) were measured. There were significant reductions of body weight and body mass index (BMI), body fat, body fat percentage, waist-hip ratio, visceral fat, and obesity in each group before and after gastric banding surgery. Results of AST, ALT, and HbA(1c) had significant reductions in each group. For HbA(1c), treatment rate was 71% in the MO group with T2DM with significant reduction of 22.8%. It is thought that a gastric banding surgery is one of the breakthrough methods not only for weight loss but also for the prevention of complication of the obese patients with T2DM. Thus, gastric banding surgery could be effective in controlling HbA(1c) in obese patients with type 2 diabetes mellitus.

Keyword

Morbidly obesity; Type 2 diabetes mellitus; Gastric banding surgery; Hemoglobin A1c

MeSH Terms

Adipose Tissue
Alanine Transaminase
Aspartate Aminotransferases
Body Mass Index
Body Weight
Cholesterol
Diabetes Mellitus, Type 2*
Hemoglobin A, Glycosylated
Humans
Insulin Resistance
Intra-Abdominal Fat
Medical Records
Obesity
Retrospective Studies
Triglycerides
Waist-Hip Ratio
Weight Loss
Alanine Transaminase
Aspartate Aminotransferases
Cholesterol

Figure

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  Figure 1 The ratio of changes of biochemical parameters in MOD and MO patients. MOD, morbidly obese patients with diabetes; MO, morbidly obese; TG, triglycerides; TC, total cholesterol; AST, aspartate transaminase; ALT, alanine transaminase; HbA1c, glycated hemoglobin. *Significantly different between the values at MOD and MO groups by paired t-test (p < 0.05).

Reference

1. Kumar A, Nayak BP, Kumar A. Obesity: single house for many evils. Minerva Endocrinol. 2016; 41:499–508.

2. Korea Centers for Disease Control and Prevention. National nutrition survey report [Internet]. Cheongju: Korea Centers for Disease Control and Prevention;2015. cited 2016 December 21. Available from: https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do?classType=7.

3. Statistics Korea. The statistics of mortality and the causes [Internet]. Daejeon: Statistics Korea;2015. cited 2016 September 27. Available from: http://www.kostat.go.kr.

4. Kang K, Sung J, Kim CY. High risk groups in health behavior defined by clustering of smoking, alcohol, and exercise habits: National Heath and Nutrition Examination Survey. J Prev Med Public Health. 2010; 43:73–83.

5. Lim S, Shin H, Song JH, Kwak SH, Kang SM, Won Yoon J, Choi SH, Cho SI, Park KS, Lee HK, Jang HC, Koh KK. Increasing prevalence of metabolic syndrome in Korea: the Korean National Health and Nutrition Examination Survey for 1998–2007. Diabetes Care. 2011; 34:1323–1328.

6. Jang YH, In DH, Yang JK, Moon HJ, Yoon GT, Ryu AJ, Kim YJ, Lee EY, Kim HJ, Ku BJ, Lee JM, Park KS, Lee IS, Lee JM, Lim DM, Park KY, Kim SJ. The effect of vildagliptin on visfatin in Korean patients with type 2 diabetes: a multicenter, double-blind, randomized, placebo-controlled, prospective study. J Korean Diabetes. 2015; 16:303–309.

7. Kang JH, Jeong BG, Cho YG, Song HR, Kim KA. Medical expenditure attributable to overweight and obesity in adults with hypertension, diabetes and dyslipidemia: evidence from Korea National Health and Nutrition Examination Survey data and Korea National Health Corporation data. J Agric Med Community Health. 2010; 35:77–88.

8. Adeghate E. Visfatin: structure, function and relation to diabetes mellitus and other dysfunctions. Curr Med Chem. 2008; 15:1851–1862.

9. Kenkel DS, Manning W. Economic evaluation of nutrition policy: or, there’s no such thing as a free lunch. Food Policy. 1999; 24:145–162.

10. Colditz GA. Economic costs of obesity and inactivity. Med Sci Sports Exerc. 1999; 31:S663–S667.

11. Ahn BC, Joung H. Socioeconomic cost of obesity in Korea. Korean J Nutr. 2005; 38:786–792.

12. Jang JH. Psychological support before and after obesity metabolic operation is tried. J Korean Diabetes. 2013; 14:75–78.

13. Kim HJ, Namgung SA, Hong JI, Mok HJ. A study on the standards of medical-nutritional-education by the type of bariatric surgery in morbid-obesity patients. J Korean Diet Assoc. 2010; 16:178–187.

14. Ahn HS, Lee HJ, Kang SH, Kim GJ, Kim SS, Kim YJ, Kim W, Kim EK, Kim JH, Kim JH, Kim JH, Kim JJ, Ryu SY, Ryu SW, Park DJ, Park SS, Park YC, Park JM, Seo KW, Suh BJ, Ahn SH, Ahn SM, Ahn JY, Lee SK, Lee JH, Lee HH, Lee HC, Jeong GA, Jeong MR, Cho MY, Choi YB, Han SM, Han SU, Hur KY, Heo YS, Hyung WJ, Cho SH. 2013 Nationwide bariatric and metabolic surgery report in Korea. J Metab Bariatr Surg. 2014; 3:38–43.

15. Guidone C, Manco M, Valera-Mora E, Iaconelli A, Gniuli D, Mari A, Nanni G, Castagneto M, Calvani M, Mingrone G. Mechanisms of recovery from type 2 diabetes after malabsorptive bariatric surgery. Diabetes. 2006; 55:2025–2031.

16. Han SM, Kim WW. Early management of type 2 diabetes mellitus after sleeve gastrectomy in morbid obesity. J Korean Surg Soc. 2005; 69:304–309.

17. Schindler K, Prager G, Ballaban T, Kretschmer S, Riener R, Buranyi B, Maier C, Luger A, Ludvik B. Impact of laparoscopic adjustable gastric banding on plasma ghrelin, eating behaviour and body weight. Eur J Clin Invest. 2004; 34:549–554.

18. Giusti V, Suter M, Héraïef E, Gaillard RC, Burckhardt P. Effects of laparoscopic gastric banding on body composition, metabolic profile and nutritional status of obese women: 12-months follow-up. Obes Surg. 2004; 14:239–245.

19. World Health Organization Western Pacific Region. International Association for the Study of Obesity. International Obesity Task Force. The Asia-pacific perspective: redefining obesity and its treatment. Sydney: Health Communications Australia Pty Limited;2000.

20. Fujioka S, Matsuzawa Y, Tokunaga K, Tarui S. Contribution of intra-abdominal fat accumulation to the impairment of glucose and lipid metabolism in human obesity. Metabolism. 1987; 36:54–59.

21. Chiba Y, Saitoh S, Takagi S, Ohnishi H, Katoh N, Ohata J, Nakagawa M, Shimamoto K. Relationship between visceral fat and cardiovascular disease risk factors: the Tanno and Sobetsu study. Hypertens Res. 2007; 30:229–236.

22. Carey DG, Pliego GJ, Raymond RL. Body composition and metabolic changes following bariatric surgery: effects on fat mass, lean mass and basal metabolic rate: six months to one-year follow-up. Obes Surg. 2006; 16:1602–1608.

23. Sjöström L, Narbro K, Sjöström CD, Karason K, Larsson B, Wedel H, Lystig T, Sullivan M, Bouchard C, Carlsson B, Bengtsson C, Dahlgren S, Gummesson A, Jacobson P, Karlsson J, Lindroos AK, Lönroth H, Näslund I, Olbers T, Stenlöf K, Torgerson J, Agren G, Carlsson LM; Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007; 357:741–752.

24. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004; 292:1724–1737.

25. Pories WJ, Swanson MS, MacDonald KG, Long SB, Morris PG, Brown BM, Barakat HA, deRamon RA, Israel G, Dolezal JM, Dohm L. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg. 1995; 222:339–350.

26. Sacks DB, Bruns DE, Goldstein DE, Maclaren NK, McDonald JM, Parrott M. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem. 2002; 48:436–472.

27. LeRoith D, Smith DO. Monitoring glycemic control: the cornerstone of diabetes care. Clin Ther. 2005; 27:1489–1499.

28. Lind M, Odén A, Fahlén M, Eliasson B. The true value of HbA_1c as a predictor of diabetic complications: simulations of HbA_1c variables. PLoS One. 2009; 4:e4412.

29. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346:393–403.

30. Baek YA, Kim KN, Lee YA, Chang N. The effect of nutrition education on visceral fat reduction and diet quality in postmenopausal women. Korean J Nutr. 2008; 41:634–644.

31. Mummadi RR, Kasturi KS, Chennareddygari S, Sood GK. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2008; 6:1396–1402.