Endoscopically implanted device improves glycemic control, weight loss in diabetes, severe obesity

Adults with poorly controlled type 2 diabetes and severe obesity saw sustained reductions in body weight and HbA1c after receiving an endoscopically implanted weight-loss device for 1 year along with lifestyle intervention, according to findings presented at the European Association for the Study of Diabetes Annual Meeting.

The EndoBarrier (GI Dynamics) is a thin plastic sleeve that lines the first 60 cm of the small intestine, causing food to be absorbed further down in the intestine, according to a description from the manufacturer. In a small study, Robert Ryder, MD, consultant diabetologist at City Hospital in Birmingham, United Kingdom, and colleagues analyzed data from 31 adults with type 2 diabetes and obesity aged 28 to 62 years who had the device implanted after October 2014 and removed after 1 year (mean age, 51 years; 58% men; 48% white; mean diabetes duration, 13.3 years). Within the cohort, 54.8% were on insulin therapy. All participants were also counseled on lifestyle management.

At the time devices were removed, mean BMI for patients had fallen from 41.5 kg/m² to 35.8 kg/m², HbA1c from 9.6% to 7.3% and systolic blood pressure from 137.3 mm Hg to 124.9 mm Hg. Additionally, mean total daily insulin dose decreased from 100 U to 30 U.

The researchers noted that two patients had the device removed early, one due to gastrointestinal hemorrhage and the other due to a liver abscess, and early removal resolved both events. Of the 17 patients who reached 6 months after device removal, 65% have maintained improvements in weight loss and diabetes control, the researchers wrote.

Six patients in the cohort experienced deteriorating HbA1c and weight gain after device removal; of those, five patients reported depressive symptoms, according to researchers.

“After EndoBarrier removal, 65% were able to sustain the benefits in HbA1c, weight, insulin dose and reduction in liver fat ... and they reported considerable improvements in well-being, energy and exercise ability,” the researchers wrote in an abstract. “As endoscopy units are ubiquitous, our service could be readily disseminated, with the registry useful for ongoing monitoring worldwide.” – by Regina Schaffer

Reference:

Ryder REG, et al. Poster 701. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 11-15, 2017; Lisbon, Portugal.

Disclosure: Ryder reports he is a consultant for GI Dynamics.