New device shows promise as treatment for obesity and diabetes
A new NHS service to provide a non-surgical reversible weight loss device for people who have both poorly controlled type 2 diabetes and obesity is safe and effective and should be rolled out across the NHS, according to new research presented at the recent European Association for the Study of Diabetes (EASD) Annual Meeting in Lisbon, Portugal.
Previous research suggested that the endoscopically implanted ‘Endobarrier’ device can improve diabetes control and promote weight loss. In this study, Dr Robert Ryder and colleagues from City Hospital, Birmingham, UK, created a small NHS Endobarrier service for people having difficulties managing their type 2 diabetes and obesity. The service was set up in October 2014 to help the hardest-to-treat cases. Of the 65 adults accepted for treatment, 50 have already had an Endobarrier implanted.
The study reported the outcomes of the first 31 participants (age between 28 and 62 years) to have their device removed after up to 1 year. These patients had lived with type 2 diabetes for an average of 13 years, and over half (17 patients) were taking insulin. While the device was implanted, all participants were regularly encouraged to improve diet and lifestyle. The researchers also established a secure online registry to monitor outcomes.
The participants lost a significant amount of weight, had improved blood sugar control, and substantially reduced systolic blood pressure and liver fat. In those taking insulin, median daily insulin dose reduced from 100 to 30 units (Table). Of the 17 patients who have reached 6 months post Endobarrier treatment, 11 (65%) have managed to maintain the substantial improvements in weight loss and diabetes control. Participants also reported improvements in wellbeing, energy, and the ability to exercise, with 94% saying that they would recommend the service to their friends and family.
|Parameter||Improvements seen (p)|
|Weight (kg)||-15.6 ± 9.2 (<0.001)|
|BMI (kg/m2)||-5.7 ± 3.5 (<0.001)|
|HbA1c (%)||-2.3 ± 2.2 (<0.001)|
|Systolic blood pressure||-12.4 ± 17.1 (<0.001)|
|Total daily insulin dose (units)||- 70 (0.003)|
Table: Key outcomes after 1 year treatment (n=31).
The Endobarrier prevents food from coming into contact with the first part of the small intestine, without painful invasive surgery. The device consists of a 60cm long tube-like sleeve that coats the inside of the small intestine - allowing food to pass through but not to be absorbed. The device is removed after a year. The procedure aims to kick start a change in lifestyle and help people achieve better health.
Endobarrier therapy is highly effective in patients with obesity and diabetes that has been very hard to treat, with high patient satisfaction levels, and an acceptable safety profile. The Endobarrier service could be a safe and cost-effective treatment for the NHS.
Ryder REJ et al. Efficacy, safety, and tolerability and sustainability outcomes of endoscopic proximal intestinal exclusion with EndoBarrier: 1st UK NHS EndoBarrier service for diabesity. Presented at 2017 European Association for the Study of Diabetes (EASD) Annual Meeting in Lisbon, Portugal. Abstract 701.