• Obesity
• Diabetes Mellitus
• Diabetes & Endocrinology Clinical Trials

Investigators from a study on the EndoBarrier® Gastrointestinal Liner in subjects with type 2 diabetes and obesity report that EndoBarrier treatment produces rapid and long-lasting weight loss, improvement in diabetes, and beneficial hormonal effects that are similar to surgical interventions, such as Roux-en-Y gastric bypass. Charlotte de Jonge, MD, Maastricht University Medical Centre, Maastricht, The Netherlands, presented the results.

In the study, 17 patients (14 males and 3 females) with obesity (body mass index of 30 kg/m² to 50 kg/m²) and type 2 diabetes were implanted with the EndoBarrier for 24 weeks. Patients were evaluated to assess levels of HbA1C, glucose, insulin, GLP-1, and PYY prior to and at 24 weeks after endoscopic implantation through blood draws that were conducted during meal tolerance tests using a 500-kcal test meter. The aim of the study was to investigate mechanisms that underlie diabetic improvement after duodenal exclusion by duodenaljejunal bypass treatment.

Treatment with the EndoBarrier resulted in a rapid and sustained increase in insulin sensitivity, increased levels of both PYY and GLP-1, 1 week postplacement, reduction in mean HbA1C levels of 1.4% (from 8.4% at baseline to 7.0%), normalization of glucagon response, mean excess weight loss of 29.8%, and elimination of or reduction in use of antidiabetic medications in 16 of 17 participants.

“Our data show that treatment with the EndoBarrier affects key hormones involved in insulin sensitivity, glucose metabolism, and satiety, similar to the impact of gastric bypass, and these changes allow for rapid and sustained improvement in patients with type 2 diabetes,” said Prof. de Jonge. “In addition, we found that patients maintained diabetic improvements at the end of the follow-up period, 1 week postremoval. These are important findings in understanding how the EndoBarrier works to treat type 2 diabetes.”

The intestine is an important metabolic organ that has gained attention in recent years for the newly identified role that it plays in the pathophysiology of various metabolic diseases, including obesity, insulin resistance, and diabetes. Recent insights regarding the role of enteroendocrine hormones, such as GIP, GLP-1, and PYY, in metabolic diseases, as well as the emerging role of the gut microbial community and gastric bypass surgeries in modulating metabolic function and dysfunction, have sparked a wave of interest in understanding the mechanisms that are involved in an effort to identify new therapeutics and novel regulators of metabolism [Bradley WD et al. Arch Physiol Biochem 2011].

Gut hormones contribute to glycemic control, the regulation of food intake, and weight loss. Previous research has demonstrated that bariatric surgery in obese patients with type 2 diabetes has immediate effects and improvements in glycemic control and that these effects may be due to changes in gut hormones [Blackburn GL et al. Obesity 2009]. The EndoBarrier, a liner that fits inside a section of the intestine, mimics many of the effects of gastric bypass but without the surgery.

• © 2011 MD Conference Express®