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Impact of Gastric Banding Versus Metformin on β-Cell Function in Adults With Impaired Glucose Tolerance or Mild Type 2 Diabetes.

Citation
Xiang, A. H., et al. “Impact Of Gastric Banding Versus Metformin On Β-Cell Function In Adults With Impaired Glucose Tolerance Or Mild Type 2 Diabetes.”. Diabetes Care, pp. 2544-2551.
Center Indiana University University of Chicago University of Washington Yale University
Multicenter
Multicenter
Author Anny H Xiang, Enrique Trigo, Mayra Martinez, Namir Katkhouda, Elizabeth Beale, Xinhui Wang, Jun Wu, Ting Chow, Cortney Montgomery, Krishna S Nayak, Fadi Hendee, Thomas A Buchanan, RISE Consortium, RISE Collaborators
Abstract

OBJECTIVE: Type 2 diabetes (T2D) results from progressive loss of β-cell function. The BetaFat study compared gastric banding and metformin for their impact on β-cell function in adults with moderate obesity and impaired glucose tolerance (IGT) or recently diagnosed, mild T2D.

RESEARCH DESIGN AND METHODS: Eighty-eight people aged 21-65 years, BMI 30-40 kg/m, with IGT or diabetes known for <1 year, were randomized to gastric banding or metformin for 2 years. Hyperglycemic clamps (11.1 mmol/L) followed by arginine injection at maximally potentiating glycemia (>25 mmol/L) were performed at baseline, 12 months, and 24 months to measure steady-state C-peptide (SSCP) and acute C-peptide response to arginine at maximum glycemic potentiation (ACPRmax) and insulin sensitivity (M/I).

RESULTS: At 24 months, the band group lost 10.7 kg; the metformin group lost 1.7 kg ( < 0.01). Insulin sensitivity increased 45% in the band group and 25% in the metformin group ( = 0.30 between groups). SSCP adjusted for insulin sensitivity fell slightly but not significantly in each group ( = 0.34 between groups). ACPRmax adjusted for insulin sensitivity fell significantly in the metformin group ( = 0.002) but not in the band group ( = 0.25 between groups). HbA fell at 12 and 24 months in the band group ( < 0.004) but only at 12 months ( < 0.01) in the metformin group ( > 0.14 between groups). Normoglycemia was present in 22% and 15% of band and metformin groups, respectively, at 24 months ( = 0.66 between groups).

CONCLUSIONS: Gastric banding and metformin had similar effects to preserve β-cell function and stabilize or improve glycemia over a 2-year period in moderately obese adults with IGT or recently diagnosed, mild T2D.

Year of Publication
2018
Journal
Diabetes care
Volume
41
Issue
12
Number of Pages
2544-2551
Date Published
12/2018
ISSN Number
1935-5548
DOI
10.2337/dc18-1662
Alternate Journal
Diabetes Care
PMID
30282699
PMCID
PMC6245202
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