Electrical Stimulation as Treatment for Obesity and Diabetes

Abstract

The prevalence of obesity is growing, is driving an increase in the prevalence of diabetes, and is creating a major public health crisis in the United States. Lifestyle and behavior therapy rarely give durable weight loss. There are few medications approved for the treatment of obesity. Those that exist are limited in efficacy and using them in combination does not result in greater weight loss. Surgical treatments for obesity are effective and give durable weight loss, but are accompanied by measurable morbidity and mortality. Several pacing approaches are being tried and are an outgrowth of pacing for gastroparesis. The Transcend(R) pacemaker blocks vagal efferents and delays gastric emptying, giving a 40% loss of excess body weight, if certain screening procedures are employed. The Tantulus pacemaker is still in development but increases antral muscular contractions and delays gastric emptying by stimulation during the absolute refractory period. Weight loss has been 30% of excess body weight, and glycohemoglobin decreased 1.6% in a trial of obese type 2 diabetes. Stimulation to the subdiaphragmatic sympathetics, vagal nerve stimulation with or without unilateral vagotomy, and intestinal pacing are other approaches that are still being evaluated preclinically. Clearly a safe, effective, and durable treatment for obesity is desperately needed. Electrical pacing of the gastrointestinal tract is promising therapeutically, and because pacemakers work through different mechanisms, combining pacemaker treatments may be possible. Rapid progress is being made in the field of electrical stimulation as a treatment for obesity and even greater progress can be expected in the foreseeable future.

A Pilot Study to Evaluate the Effect of Splanchnic Nerve Stimulation on Body Composition and Food Intake in Rats

“…3 The two rats that received low intensity stimulation first (1 mA followed by 3 mA) significantly increased their metabolic rate at the end of week 6 (p<0.02). However, the other two rats that received a high-intensity (3 mA) stimulation prior to the low-intensity (1 mA) electrical stimulation did not increase their metabolic rate (p>0.05) Our previous study stimulating the celiac ganglia documented a voltage-dependent increase in metabolic rate peaking at 6 V [1]. The current study stimulated the common splanchnic nerve that innervates the celiac ganglia where the two branches of the splanchnic nerves converge.…”

“…Stimulation of the autonomic nervous system for the treatment of obesity has been explored since the 1990s, but most attempts have focused upon the vagus nerve [1]. Obesity driven by vagal overactivity as in hypothalamic obesity, however, is rare [2].…”

A Pilot Study to Compare Meal-Triggered Gastric Electrical Stimulation and Insulin Treatment in Chinese Obese Type 2 Diabetes

“…In these patients, the maximum weight loss of 5% occurred at 6 months, which was comparable to the experiences in white populations. [14][15][16] The concomitant reduction in WC and body fat percentage supported the effects of GCM on body composition. By augmenting the food-stimulated gastric contraction, GCM has been shown to improve satiety and reduce food intake in both canine 13 and human 16 models.…”

“…13 In human studies, gastric electrical stimulation caused weight loss in obese individuals, although the sample size was small with variable effects. 14 The DIAMOND (TANTALUSÔ II) (MetaCure, KfarSaba, Israel) is a new gastric stimulatory device that uses gastric contraction modulation to enhance gastric antral contractility during food ingestion. 15,16 In open-label controlled trials, the TANTALUS II improved glycemic control and caused weight loss in T2D patients without OADs.…”

Updates on gastric electrical stimulation to treat obesity: Systematic review and future perspectives

“…The gastric electrical stimulator (GES) has been identified as a potential alternative minimally invasive surgery, based on the growing knowledge on gastrointestinal physiology [23] . The concept of GES to treat obesity was initially proposed in 1995 by Cigaina [15,24,25] who demonstrated the proof of the concept in a series of animal experiments.…”