Alarmingly, the UK has the fastest growing rate of obesity in the developed world [1,2] and it is estimated that in the UK, the number of obese people with type 2 diabetes has increased by one million over the past five years [2,3]. Recent estimates are that ten per cent of the National Health Service spending goes on diabetes; this equates to £9 billion a year – that's £1 million an hour [4]. Current lifestyle and pharmacological approaches are only modestly successful in causing sustained weight loss in obese people with type 2 diabetes [5–7].
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 40kg/m2 and who have other significant diseases such as type 2 diabetes or high blood pressure or for those with a BMI greater than 40kg/m2 [8]. Now, after a recent decision by TUV SUD, an EU-notified body responsible for the certification of medical devices, Allergan's LAP-BAND™ AP System for obesity intervention has become the first device to receive official European approval for weight loss that leads to improvement or remission of type 2 diabetes.
The LAP-BAND™ AP System is intended to aid long-term weight loss and reduce the health risks associated with severe and morbid obesity. Using laparascopic (keyhole) techniques, an inflatable silicone band is placed around the top portion of the patient's stomach, creating a small pouch. This reduces the patient’s stomach capacity and creates an earlier feeling of satiety.
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.’
The evidence leading to the expanded product label comes from a two-year randomized controlled clinical study, which showed that patients who lost weight with the LAP-BAND™ AP System more than five times more likely to achieve remission of type 2 diabetes than those receiving conventional diabetes therapy (73% vs 13%). This is the first randomized controlled study to compare surgically induced weight loss with conventional therapy for management of type 2 diabetes in obese patients. These results confirm the findings of previous observational studies [9].
References
1 Zimmet, P. et al. (2001) Global and societal implications of the diabetes epidemic. Nature 414, 782–787
2 (2008) Diabetes – the policy puzzle: is Europe making progress? FEND & IDF Europe report, second edition
3 (2004) Diabetes in the UK 2004. A report from Diabetes UK
4 (2008) Diabetes. Beware the silent assassin. A report from Diabetes UK
5 Khan, M.A. et al. (2000) Diabetes disease stage predicts weight loss outcomes with long-term appetite suppressants. Obes. Res. 8, 43–48
6 Zimmet, P. et al. (2003) Preventing type 2 diabetes and the dysmetabolic syndrome in the real world: a realistic view. Diabet. Med. 20, 693–702
7 Wing, R.R. et al. (1987) Type II diabetic subjects lose less weight than their overweight nondiabetic spouses. Diabetes Care 10, 563–566
8 (2006) Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and Children. NICE Guideline
9 Dixon, J.B. et al. (2008) Adjustable gastric banding and conventional therapy for type 2 diabetes: a randomized controlled trial. J. Am. Med. Assoc. 299