SLIMM-T2D: Gastric Banding vs. Intensive Diabetes, Weight Management Program

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SLIMM-T2D: Gastric Banding vs. Intensive Diabetes, Weight Management Program
SLIMM-T2D: Gastric Banding vs. Intensive Diabetes, Weight Management Program

After 1 year, treatment with laparoscopic adjustable gastric band (LAGB) yielded improvements in blood glucose in obese patients with type 2 diabetes that were comparable to those seen with an intensive diabetes medical and weight management program, researchers reported in the Journal of Clinical Endocrinology & Metabolism.

“We can anticipate long-term health benefits from both of these approaches, but they do require some investment of time and energy by the patient,” study researcher Allison Goldfine, MD, head of Joslin Diabetes Center's Section of Clinical Research and an associate professor of medicine at Harvard Medical School, said in a press release.

Study Details

Previous research has shown that bariatric surgery, including LABG, can result in significant improvements in weight, glucose tolerance, blood pressure (BP) and lipids in patients with type 2 diabetes.

However, in light of improvements in diabetes pharmacotherapy and increased knowledge about multidisciplinary approaches to lifestyle-based interventions, recommendations for surgical vs. lifestyle and pharmacologic-based treatment for type 2 diabetes remain controversial, according to background information in the article.

To compare these approaches, Goldfine and colleagues conducted the Surgery or Lifestyle with Intensive Medical Management in Treatment of Type 2 Diabetes (SLIMM-T2D) trial.

In the study, the researchers randomly assigned 45 participants (mean age, 51 years; mean BMI, 36.5) who had type 2 diabetes for more than 1 year to undergo an LABG procedure (n=23) or Joslin Diabetes Center's Why WAIT (Weight Achievement and Intensive Treatment; n=22).

Why WAIT employs a multidisciplinary approach that includes an endocrinologist, dietician, exercise physiologist, mental health provider and diabetes nurse educator with 2-hour weekly group sessions over 12 weeks. Medications are adjusted using a prespecified algorithm, and patients participate in supervised group exercise and support or didactic sessions.

Five participants did not undergo LABG, according to the researchers.

Results

Of the remaining 40 who went through with their assigned interventions, 33% of the LABG group and 23% of the Why WAIT group met the primary glycemic endpoint, defined as HbA1c lower than 6.5% and fasting glucose of 7.0 mmol/L at 12 months (P=.457).

At 3 and 12 months, reduction in HbA1c was similar in both groups (–1.2% vs. –1.0%; P=.496). Similarly, weight loss was comparable at 3 months but greater at 12 months in the LABG group (–13.5 kg vs. –8.5 kg; P=.027).

Although the researchers noted greater reductions in systolic BP in the Why WAIT group vs. the LAGB group, changes in diastolic BP, lipids, fitness and cardiovascular risk scores were also similar.

Equivalent improvements in patient-reported health status, as measured by the Short Form-36, Impact of Weight on Quality of Life and Problem Areas in Diabetes, were achieved in both groups.

Clinical Implications

As a result of their findings, the researchers concluded: “These findings suggest LAGB and [intensive diabetes medical and weight management] as provided by the Why WAIT program have generally similar benefits on diabetes control, cardiometabolic risk and quality-of-life parameters. These results may be useful in guiding obese patients with [type 2 diabetes] when they explore their options for glycemic and weight management.”

"It's really important to have a variety of different approaches available to treat a complex medical problem like diabetes, and we need to understand the relative merits of each approach," Goldfine said. "There are people for whom remembering to take their medications is highly problematic, and there are people for whom the idea of surgical risk is unbearable. One size does not fit all."

Reference

  1. Ding S-A et al. J Clin Endocrinol Metab. 2015; doi:10.1210/jc.2015-1443.
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