2011 ADA Posters 1261-2041.indd - Diabetes

Integrated Physiology/
Obesity
POSTERS
different metabolic conditions can induce signifi cantly divergent exhaled gas
profi les. Integrations of this information into condition-specifi c predictive
models (for instance use of different gases in predictive algorithms for
glycemia in obese, T1DM and T2DM) is likely to considerably improve
accuracy of breath based measurements of plasma variables, accelerating
the development of portable, clinically usable breath testing devices.
Supported by: NIH 1UL1RR031985, K24 DK085223 ADA-Funded Research
1889-P
Early Aggressive Weight Loss Efforts Using Adjustable Gastric Banding
Leads to Improvement or “Remission” of Type 2 Diabetes Mellitus
TED OKERSON, MICHAEL OEFELEIN, SUNIL BHOYRUL, PAMELA BARNETT, JOHN
B. DIXON, APEX, Irvine, CA, La Jolla, CA, Melbourne, Australia
Bariatric surgery (malabsorptive or restrictive techniques) has been
established as an effective treatment to reduce weight in severely obese
patients. This study reports the 1 year “remission” (elimination of hypoglycemic
medication) and/or improvement (reduction in hypoglycemic
medication) of type 2 diabetes mellitus (T2D) after laparoscopic placement
of an adjustable gastric band (AGB) as documented by T2D medication
reduction/discontinuation, and the accompanying change in BMI and comorbidities.
The APEX study is an ongoing 5-year, prospective, multi-center,
open-label, observational study to assess weight reduction, co-morbidities
and quality of life after implantation of the LAP-BAND AP ® gastric band, a
restrictive weight loss technique. This is an interim analysis of subjects who
reported daily medical therapy for T2D before AGB and who have completed
the 1 year post-operative scheduled visit. At baseline (BL), 94 out of 436
subjects (22%) reported T2D requiring daily medical therapy; data from 64
subjects contained suffi cient information to assess outcome at 48 weeks.
Overall, 86% had remission and/or improvement in T2D, with remission more
likely to occur in patients treated earlier after the diagnosis of T2D:
Remission Improvement Stable Worse
%(n) 34 (22) 52 (33) 13 (8) 2 (1)
Mean Duration T2D(mo) 63 76 90 1
BL BMI 46 44 52 47
Δ BMI -8.9 -7.6 -8.1 -2.9
Δ Wt (lb) -55 -48 -52 -18
% Wt Δ -19 -21 -15 -6
Baseline BMI, reductions in BMI and % change in weight were not
statistically different among the groups, although numbers were small.
As in patients with T2D, resolution or improvement also occurred in other
pre-existing co-morbidities measured: hypertension (78%), hyperlipidemia
(57%), depression (71%), obstructive sleep apnea (69%) and GERD (93%).
These data suggest that a minimally-invasive restrictive gastric banding
procedure in obese patients with T2D results in clinically meaningful weight
loss, as well as a reduction in T2D medication requirements, with an earlier
For author disclosure information, see page 785.
OBESITY—HUMAN
CATEGORY
A510
aggressive weight loss intervention being more likely to facilitate remission
of disease. Larger and longer-term studies are required.
Supported by: Allergan
1890-P
Ectopic Fat Accumulation and Metabolic Syndrome (MSYN) Are Associated
with Reduced Subcutaneous Adipose Tissue (SAT) Lipid Storage
in Obese Postmenopausal Women (OPW)
MONICA C. SERRA, ALICE S. RYAN, RONALD L. PRIGEON, ANDREW P. GOLDBERG,
Baltimore, MD
Impaired expandability of SAT and the accumulation of fat in visceral
adipose tissue (VAT) and muscle (Low Density Lean Tissue [LDLT]) may lead to
metabolic dysfunction in obesity. We hypothesize that a decreased ability to
store triglycerides (TG) in SAT, due to low adipose lipoprotein lipase activity
(LPL), results in lipid overfl ow into VAT and LDLT stores, insulin resistance (IR
[measured by HOMA-IR]) and MSYN. To test this hypothesis we measured
body composition (DXA, CT), MSYN variables, fat cell weight (FCW) and
LPL in abdominal and gluteal adipose biopsies in 125 Caucasian overweight
and OPW (25-44 kg/m 2 ; age 45-77 yrs) grouped into lowest and highest
quintiles of VAT/total abdominal fat (VAT/[VAT+SAT]; mean±SD: 0.17±0.02
vs. 0.37±0.05). OPW in the highest quintile had a greater prevalence of
impaired glucose tolerance (IGT; 67% vs. 20%, P