LAGB effective and acceptable in indigenous Australians

By Nicola Garrett

22 May 2015

Gastric banding in obese indigenous people with diabetes is effective, feasible and acceptable to the people, researchers from Monash say.

Writing in Obesity Surgery the researchers led by Paul O’Brien from the Centre for Obesity Research and Education at Monash University said that studies had shown LAGB was an effective treatment for type 2 diabetes in obese non-indigenous people, but cautioned that the translation of an effect should not be assumed in indigenous populations.

“There are differences in attitudes, behaviour and culture that mean the acceptability to the indigenous person of a surgical approach to obesity/diabetes management and compliance with the aftercare requirements for LAGB should not be taken for granted,” they wrote.

The current study involved 30 obese (BMI > 30kg/ m2) indigenous adults from the Rumbalara Aboriginal Co-operative in Central Victoria who were followed for two years following laparoscopic adjustable gastric banding (LAGB).

The research team then compared outcomes with non-indigenous Australians from an earlier randomized controlled trial using a similar protocol.

The diabetes remission* rate of 77 % (n=20) of the 26 who completed the follow-up and final assessments was not different to that seen by the same treatment program in metropolitan non-indigenous Australians, the researchers said.

Overall an average weight loss of 26.2±14 kg was achieved and BMI reduced from 44.3 to 34.4 kg/m2, a change of 9.9 BMI units.

However 12 late adverse events occured, 9 more than were seen in the comparator study.

According to the authors 10 were associated with injury and/or infection at the access port and most likely reflected inexperience within the healthcare team in performing band adjustments.

This was an issue that could be corrected with better training and greater experience, the study authors said.

Type 2 diabetes is more common and more lethal in the indigenous people of Australia, and yet they have little access to a treatment program that has the strong potential to bring their diabetes into remission.

“The federal government of Australia has repeatedly expressed a commitment to overcoming indigenous disadvantage and closing the gap between indigenous and non-indigenous health outcomes,” they said.

This study offers a direction along that pathway, they added.

*Diabetes remisson was defined as a fasting blood glucose < 7.0 mmol/L and haemoglobin A1c (HbA1c) < 6.2 % while off all therapy except metformin.

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