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Obes Surg. 2017 Mar;27(3):569-577. doi: 10.1007/s11695-016-2311-0.

Endobarrier® in Grade I Obese Patients with Long-Standing Type 2 Diabetes: Role of Gastrointestinal Hormones in Glucose Metabolism.

Author information

1
Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, c/ Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain. nuriavilarrasa@yahoo.es.
2
CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain. nuriavilarrasa@yahoo.es.
3
Bariatric Surgery Unit, Hospital Universitario de Bellvitge-IDIBELL, c/ Feixa Llarga s/n 08907, LHospitalet de Llobregat, Barcelona, Spain.
4
Hospital Universitari de Tarragona Joan XXIII, Institut Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, 43007, Tarragona, Spain.
5
Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, c/ Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
6
Unit of Endoscopy Gastrodex, Hospital Universitario Dexeus, Sabino Arana, 5-19, 08028, Barcelona, Spain.
7
Unit of Endoscopy. Gastro-obeso Center, Rua Barata Ribeiro, 237, Sao Paulo, SP, 01308-000, Brazil.
8
CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain.
9
Bariatric Surgery Unit, Hospital Universitario de Bellvitge-IDIBELL, c/ Feixa Llarga s/n 08907, LHospitalet de Llobregat, Barcelona, Spain. jpujol@bellvitgehospital.cat.

Abstract

BACKGROUND:

The purpose of this study was to evaluate the efficacy and safety of Endobarrier® in grade 1 obese T2DM patients with poor metabolic control and the role of gastro-intestinal hormone changes on the metabolic outcomes.

METHODS:

Twenty-one patients aged 54.1 ± 9.5 years, diabetes duration 14.8 ± 8.5 years, BMI 33.4 ± 1.9 kg/m2, and HbA1c 9.1 ± 1.3 %, under insulin therapy, were implanted with Endobarrier®. Fasting concentrations of PYY, ghrelin and glucagon, and AUC for GLP-1 after a standard meal test were determined prior to and at months 1 and 12 after implantation.

RESULTS:

Patients lost 14.9 ± 5.7 % of their total body weight. HbA1c decreased 1.3 % in the first month, but at the end of the study, the reduction was 0.6 %. HbA1c ≤ 7 % was achieved in 26.3 % of patients. No differences in GLP-1 AUC values were found before and after implant. Fasting plasma ghrelin and PYY concentrations increased from month 1 to 12. Conversely, fasting plasma glucagon concentrations decreased at month 1 and increased thereafter. Weight (β 0.152) and HbA1c decrease at month 1 (β 0.176) were the only variables predictive of HbA1c values at 12 months (adjusted R 2 for the model 0.693, p = 0.001). Minor adverse events occurred in 14 % of patients and major events in 9.5 %.

CONCLUSIONS:

Endobarrier® in T2DM patients with grade I obesity and poor metabolic control is associated with significant weight decrease and moderate reduction in HbA1c at month 12. Our data do not support a role for GLP-1 in the metabolic improvement in this subset of patients.

KEYWORDS:

Duodenal jejunal bypass liner; Endobarrier; Gastrointestinal hormones; Ghrelin; Glucagon; Glucagon-like; Grade I obese patients; Peptide 1; Peptide YY; Type 2 diabetes

PMID:
27468906
DOI:
10.1007/s11695-016-2311-0
[Indexed for MEDLINE]

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