Medical Experts Call For Greater Use Of Gastric Banding For Obese People With Type 2 Diabetes

Main Category: Obesity / Weight Loss / Fitness
Also Included In: Diabetes
Article Date: 01 Jul 2009 - 1:00 PDT

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UK experts are calling for greater consideration of gastric banding as an option for obese people with type 2 diabetes who need to lose weight. Dr Jonathan Pinkney, diabetologist, and Mr Paul Super, obesity surgeon, initiated this call to action following the recent European label change confirming that weight loss with Allergan's LAP-BAND [TM] AP System can lead to improvement or remission of type 2 diabetes. The risk of developing type 2 diabetes is increased up to 10 times in obese people and, alarmingly, the UK has the fastest growing rate of obesity in the developed world.

The recent decision by TUV SUD - a European Union notified body responsible for the certification of medical devices - recognises the LAP-BAND [TM] AP System as the first obesity intervention device in Europe to be officially approved for its effect on type 2 diabetes in obese patients through weight loss. Specifically, the LAP-BAND [TM] AP System Directions For Use (DFU) or label now states that weight loss associated with the LAP-BAND [TM] AP System has been shown to improve or lead to remission of type 2 diabetes.

"Type 2 diabetes is becoming an increasing problem as the prevalence of severe or morbid obesity in the population rises. The proven success of gastric banding procedures in these patients is timely and provides us with a powerful alternative to tackle the morbidity and mortality associated with diabesity. Diabesity was coined by Shape Up America to define the direct correlation between diabetes and obesity" said Dr Jonathan Pinkney, Consultant Senior Lecturer and Diabetologist. "The gastric banding procedure is a highly effective option for selected obese patients who are failing to reduce their weight through traditional weight-reduction methods. The recognition of a device such as the LAP-BAND™ AP System by the European health authorities is an important advance for the medical community and obese patients in our efforts to effectively manage type 2 diabetes."

Gastric banding procedures are a well-established method of achieving significant and sustained weight loss. In 2006, the National Institute of Clinical Excellence recommended bariatric surgery such as gastric banding as a treatment option for people with obesity whose Body Mass Index (BMI) is between 35kg/m2 and 40 kg/m2 and have other significant diseases such as type 2 diabetes or high blood pressure or for those with a BMI greater than 40kg/m2.

According to Mr Paul Super, bariatric surgeon specialized in obesity intervention, "There are many people who could benefit from gastric banding procedures but are currently not being referred. Given this recent development, doctors who manage obese patients with type 2 diabetes should seriously consider gastric banding as an option to help these patients get their weight down and under control. Significantly, the expanded label for the LAP-BAND™ AP System recognises its effectiveness beyond weight loss intervention to include an important role in the resolution or management of type 2 diabetes. This important label change endorses the evidence that gastric banding could reduce the burden of the management of type 2 diabetes and could result in significant cost savings to the National Health Service."

The new label is based on the results of a landmark clinical study, which showed that the LAP-BAND [TM] AP System produced remission of type 2 diabetes in the majority of obese patients studied, through weight loss. This is the first randomised controlled study to compare surgically induced weight loss with conventional therapy for management of type 2 diabetes in obese patients. Dr John Dixon & team showed that after 2 years the group treated surgically with the LAP-BAND™ AP System achieved a 5 times higher diabetes remission rate (73% vs.13%) and 4 times greater reduction in HbA1c values compared to the conventional therapy group (80% vs. 20%).

Commenting on the label Dr David Haslam from the National Obesity Forum said "Losing significant amounts of weight and then keeping the weight off is an extremely difficult task, and is especially hard for people who have been very overweight for a long time. Gastric banding can help people re-gain control of their lives while they make necessary lifestyle and diet changes. For those patients who also have the additional worry of diabetes, the long term benefit of improving or halting this disease by losing weight is very appealing."

Obesity and type 2 diabetes are likely to be the greatest public health problems of the next decade. In the United Kingdom, it is estimated that the number of obese people with type 2 diabetes has increased by 1 million over the past 5 years. To put this into perspective, recent estimates are that 10 per cent of the National Health Service (NHS) spending goes on diabetes. This equates to £9 billion a year - that's £1 million an hour. Current lifestyle and pharmacological approaches are only modestly successful in causing sustained weight loss in obese people with type 2 diabetes.

Source
Allergan, Inc