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

Xiang, Anny H.; Trigo, Enrique; Martinez, Mayra; Katkhouda, Namir; Beale, Elizabeth; Wang, Xinhui; Wu, Jun; Chow, Ting; Montgomery, Cortney; Nayak, Krishna S.; Hendee, Fadi; Buchanan, Thomas A.; RISE Consortium; Kahn, Steven E.; Arslanian, Silva A.; Edelstein, Sharon L.; Ehrmann, David A.; Nadeau, Kristen J.; Palmer, Jerry P.; Utzschneider, Kristina M.; Temple, Karla A.; Rue, Abby; Barengolts, Elena; Mokhlesi, Babak; Van Cauter, Eve; Sam, Susan; Miller, M. Annette; Atkinson, Karen M.; Gebremedhin, Tsige; Kernan-Schloss, Abigail; Kozedub, Alexandra; Morse, Emily J.; Mather, Kieren J.; Garrett, Tammy; Hannon, Tamara S.; Lteif, Amale; Patel, Aniket; Chisholm, Robin; Moore, Karen; Pirics, Vivian; Pratt, Linda; Gross, Susan; Zeitler, Philip S.; Williams, Jayne; Green, Melanie-Cree; Garcia, Yesenia; Reyes, Krista; Vissat, Kathleen; Brown, Nancy; Guerra, Kristin

doi:10.2337/dc18-1662

Cited by 37Bariatric Surgery and OutcomesDiabetes Treatment and ManagementDiabetes, Cardiovascular Risks, and Lipoproteins

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

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Xiang, Anny H., Trigo, Enrique, Martinez, Mayra, Katkhouda, Namir, Beale, Elizabeth, Wang, Xinhui, Wu, Jun, Chow, Ting +54 more·2018·Diabetes Care

DOI 10.2337/dc18-1662PMC PMC6245202

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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.

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CCI weight loss was comparable to observed weight loss following surgical gastric banding (−10.7 kg) at 2 years.
“CCI weight loss was comparable to observed weight loss following surgical gastric banding (−10.7 kg) at 2 years (59).”
From Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial (2019) · cites this paper as [59]
CCI diabetes reversal exceeds remission as prescriptions for metformin were usually continued given its role in preventing disease progression, preserving β-cell function and in the treatment of pre-diabetes per guidelines.
“CCI diabetes reversal exceeds remission as prescriptions for metformin were usually continued given its role in preventing disease progression (10, 59), preserving β-cell function (59) and in the treatment of pre-diabetes per guidelines (28).”
From Long-Term Effects of a Novel Continuous Remote Care Intervention Including Nutritional Ketosis for the Management of Type 2 Diabetes: A 2-Year Non-randomized Clinical Trial (2019) · cites this paper as [59]

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Ehrmann, D. A., Edelstein, S. L., Xiang, A. H., Buchanan, T. A., Arslanian, S. A., Caprio, S., Mather, K. J., Nadeau, K. J., & Kahn, S. E. (2020) · Diabetes · doi:10.2337/db20-1782-p
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Bi, Y., Tong, G. Y., Yang, H., Cai, M., Ma, J. H., Liang, J., Xin, B., Miao, H., Peng, Z., & Zhu, D. (2013) · Diabetes/Metabolism Research and Reviews · doi:10.1002/dmrr.2443 · Cited by 27 · see citing works

Authors: Xiang, A. H., Trigo, E., Martinez, M., Katkhouda, N., Beale, E., Wang, X., Wu, J., Chow, T., Montgomery, C., Nayak, K. S., Hendee, F., Buchanan, T. A., RISE Consortium, Kahn, S. E., Arslanian, S. A., Edelstein, S. L., Ehrmann, D. A., Nadeau, K. J., Palmer, J. P., Utzschneider, K. M., Temple, K. A., Rue, A., Barengolts, E., Mokhlesi, B., Van Cauter, E., Sam, S., Miller, M. A., Atkinson, K. M., Gebremedhin, T., Kernan-Schloss, A., Kozedub, A., Morse, E. J., Mather, K. J., Garrett, T., Hannon, T. S., Lteif, A., Patel, A., Chisholm, R., Moore, K., Pirics, V., Pratt, L., Gross, S., Zeitler, P. S., Williams, J., Green, M.-C., Garcia, Y., Reyes, K., Vissat, K., Brown, N., Guerra, K., Porter, S., Caprio, M., Savoye, B., Pierpont, J. M., Lachin, A. N., Hogan, S., Marcovina, J., Harting, J., Albers, D., Hill, P. J., Savage, & Leschek, E. W.
Affiliations: Kaiser Permanente (US)
University of Southern California (US)
University of Nevada, Reno (US)
Corresponding author: Xiang, Anny H.
Buchanan, Thomas A.
ORCID: Xiang, Anny H.
Martinez, Mayra
Beale, Elizabeth
Wang, Xinhui
Wu, Jun
Chow, Ting
Nayak, Krishna S.
Buchanan, Thomas A.
Kahn, Steven E.
Arslanian, Silva A.
Edelstein, Sharon L.
Nadeau, Kristen J.
Utzschneider, Kristina M.
Mokhlesi, Babak
Atkinson, Karen M.
Mather, Kieren J.
Hannon, Tamara S.
Zeitler, Philip S.
Harting, John
Leschek, Ellen W.
Venue: Diabetes Care
Publisher: American Diabetes Association
Published: 2018-10-03
Volume: 41
Issue: 12
Pages: 2544-2551
ISSN: 0149-5992 (ISSN-L)
1935-5548
DOI: 10.2337/dc18-1662
PMC: PMC6245202
OpenAlex: W2894960376
Cited by: 37
References: 28
Citations by year: 2026: 1 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 5 · 2021: 7 · 2020: 3 · 2019: 8 · 2018: 2
FWCI: 5.20
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.diabetesjournals.org/content/license (vor, 48 d)
Locations: Diabetes Care (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Diabetes and Digestive and Kidney Diseases (grant U01-DK-094430, U01-DK-094406, U01-DK-094431, U01-DK-094438, U01-DK-094467, P30-DK-017047, P30-DK-020595, P30-DK-045735, P30-DK-097512)
the National Center for Advancing Translational Sciences (UL1-TR-001855)
Kaiser Permanente Southern California
University of Southern California
Allergan Corporation
Apollo Endosurgery
National Center for Advancing Translational Sciences (UL1-TR-000430, UL1-TR-001082, UL1-TR-001108, UL1-TR-001855, UL1-TR-001857, UL1-TR-001858, UL1-TR-001863)
Department of Veterans Affairs
Abbott Laboratories
Novo Nordisk
Allergan
Topics: Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords: gastric banding, metformin, beta-cell function, impaired glucose tolerance, obesity, C-peptide, insulin sensitivity, bariatric surgery, hyperglycemic clamp, arginine stimulation
MeSH terms: Adult, Aged, Blood Glucose, Diabetes Mellitus, Type 2, Female, Glucose Tolerance Test, Humans, Insulin Resistance, Male, Metformin, Middle Aged, Obesity, Severity of Illness Index, Gastroplasty, Glucose Intolerance, Insulin-Secreting Cells, Young Adult

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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

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