Impact of Gastric Banding Versus Metformin on β-Cell Function in Adults With Impaired Glucose Tolerance or Mild Type 2 Diabetes
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, Steven E Kahn, Silva A Arslanian, Sharon L Edelstein, David A Ehrmann, Kristen J Nadeau, Jerry P Palmer, Kristina M Utzschneider, Karla A Temple, Abby Rue, Elena Barengolts, Babak Mokhlesi, Eve Van Cauter, Susan Sam, M Annette Miller, Karen M Atkinson, Tsige Gebremedhin, Abigail Kernan-Schloss, Alexandra Kozedub, Emily J Morse, Kieren J Mather, Tammy Garrett, Tamara S Hannon, Amale Lteif, Aniket Patel, Robin Chisholm, Karen Moore, Vivian Pirics, Linda Pratt, Susan Gross, Philip S Zeitler, Jayne Williams, Melanie-Cree Green, Yesenia Garcia, Krista Reyes, Kathleen Vissat, Nancy Brown, Kristin Guerra, Sonia Porter, Mary Caprio, Bridget Savoye, John M Pierpont, Ashley N Lachin, Santica Hogan, Jessica Marcovina, John Harting, Dave Albers, Peter J Hill, Savage, Ellen W Leschek, 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, Steven E Kahn, Silva A Arslanian, Sharon L Edelstein, David A Ehrmann, Kristen J Nadeau, Jerry P Palmer, Kristina M Utzschneider, Karla A Temple, Abby Rue, Elena Barengolts, Babak Mokhlesi, Eve Van Cauter, Susan Sam, M Annette Miller, Karen M Atkinson, Tsige Gebremedhin, Abigail Kernan-Schloss, Alexandra Kozedub, Emily J Morse, Kieren J Mather, Tammy Garrett, Tamara S Hannon, Amale Lteif, Aniket Patel, Robin Chisholm, Karen Moore, Vivian Pirics, Linda Pratt, Susan Gross, Philip S Zeitler, Jayne Williams, Melanie-Cree Green, Yesenia Garcia, Krista Reyes, Kathleen Vissat, Nancy Brown, Kristin Guerra, Sonia Porter, Mary Caprio, Bridget Savoye, John M Pierpont, Ashley N Lachin, Santica Hogan, Jessica Marcovina, John Harting, Dave Albers, Peter J Hill, Savage, Ellen W Leschek
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/m2, 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 (P < 0.01). Insulin sensitivity increased 45% in the band group and 25% in the metformin group (P = 0.30 between groups). SSCP adjusted for insulin sensitivity fell slightly but not significantly in each group (P = 0.34 between groups). ACPRmax adjusted for insulin sensitivity fell significantly in the metformin group (P = 0.002) but not in the band group (P = 0.25 between groups). HbA1c fell at 12 and 24 months in the band group (P < 0.004) but only at 12 months (P < 0.01) in the metformin group (P > 0.14 between groups). Normoglycemia was present in 22% and 15% of band and metformin groups, respectively, at 24 months (P = 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.
Trial registration: ClinicalTrials.gov NCT01763346.
© 2018 by the American Diabetes Association.
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Source: PubMed