• Obesity
• Diabetes Mellitus
• Diabetes & Endocrinology Clinical Trials

• Obesity
• Diabetes Mellitus
• Diabetes & Endocrinology Clinical Trials
• Endocrinology
• Diabetes & Metabolic Syndrome

Gastric banding surgery confers long-term (up to 17 years) protection from death and the development of cardiovascular diseases (CVD) and type 2 diabetes mellitus (T2DM) in patients with and without diabetes, according to the results of a study conducted by Antonio E. Pontiroli, MD, and colleagues, University of Milan, Milan, Italy.

Studies to date on the protection afforded by bariatric surgery have varied in their length of follow-up and number of patients and enrolled only a small number of patients with DM [Pontiroli AE, Morabito A. Ann Surg 2011] or have suffered from a lack of details or a high drop-out rate [Christou NV et al. Ann Surg 2004; Sjostrom L et al. N Engl J Med 2007; Busetto L et al. Surg Obes Relat Dis 2007; Adams TD et al. N Engl J Med 2007; Sowemimo OA et al. Surg Obes Relat Dis 2007]. The prolonged retention of patients in trials and the associated longer-term outcomes remain unclear. Furthermore, although bariatric surgery can apparently help prevent DM and lessen CVD risk [Pontiroli AE et al. Diabetes Care 2005; Heneghan HM et al. Am J Cardiol 2011; Johnson BL et al. J Am Coll Surg 2013; Busetto L et al. Surg Obes Relat Dis 2014], differences in outcomes between patients with and without diabetes remain unclear.

The present prospective, cohort record-linked study involved obese (body mass index [BMI] > 35 kg/m²) patients aged 18 to 65 years who underwent the same gastric banding procedure or received medical treatment from 1995 through 2001 at four centers in Milan. Medical records were examined for sex, age, clinical evidence of coronary heart disease (CHD) and retinopathy, anthropometric data (height, weight, BMI, systolic and diastolic blood pressures), and metabolic data (fasting blood glucose, HBA1C, total cholesterol, high- and low-density cholesterol, triglycerides, aspartate transaminase, alanine transaminase, creatinine, and estimated glomerular filtration rate). The limit date for deaths, patient exceptions, and hospital admissions was September 30, 2012. The analyses were on an intention-to-treat principle. Identification codes of all patients were entered into the Lumbardy Regional Database to ascertain patients alive, patients dead and cause of mortality, patients migrated elsewhere, and the development of new diseases.

The baseline characteristics differed between the patients who did and did not have gastric banding surgery, and therefore group matching was applied (Tables 1 and 2).

Gastric banding was associated with significantly increased survival in both the entire patient cohort and among matched patients.

The survival advantage with surgery was evident for all patients with diabetes (OR, 0.37; 95% CI, 0.14 to 0.93; p = .035), matched patients with diabetes (OR, 0.33; 95% CI, 0.13 to 0.84; p = .020), and all patients without diabetes (OR, 0.39; 95% CI, 0.20 to 0.75; p = .005), and almost achieved significance in matched patients without diabetes (OR, 0.44; 95% CI, 0.19 to 1.00; p = .052). The causes of death were not significantly different between patients who did or did not undergo gastric banding surgery.

The researchers concluded that the prevention of mortality following gastric banding continues for 15 (range, 11–17) years and is associated with the absence of the development of new diseases, in particular DM and CVD, over the same period in patients with and without diabetes. The researchers plan to undertake another round of assessments with the same cohort in 2017.

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