EndoBarrier™ Implantation Rapidly Improves Insulin Sensitivity in Obese Individuals with Type 2 Diabetes Mellitus

Abstract

The EndoBarrier™ medical device is a duodenal-jejunal bypass liner designed to mimic the effects of gastric bypass surgery to induce weight loss and glycaemic improvement. In this study, 10 participants with type 2 diabetes mellitus (T2DM), a mean body mass index (BMI) of 43.3 ± 5.0 (kg/m2) and a mean glycated haemoglobin A1c (HbA1c) of 60.6 ± 8.6 mmol/mol were examined at baseline (before implantation of EndoBarrier™), 4 weeks after implantation, at 36 weeks (right before explantation) and 24 weeks after the removal of the device to explore the short and long-term effects on glucose metabolism. Besides a significant reduction in body weight and fat mass, EndoBarrier™ treatment significantly improved insulin sensitivity during Botnia clamp investigations after four weeks of implantation. The beneficial effects decreased over time but remained significant 24 weeks after removal of the device.

Does Bypass of the Proximal Small Intestine Impact Food Intake, Preference, and Taste Function in Humans? An Experimental Medicine Study Using the Duodenal-Jejunal Bypass Liner

“…Using food diaries, our results demonstrated similarly reduced food intake within both the Endobarrier and the control groups. Similarly, a recent case series study of patients with obesity and T2DM demonstrated reduced food intake at 36 weeks after the Endobarrier implant using a semi-quantitative Food Frequency Questionnaire [ 11 ]. In contrast, a prospective observational study of two groups, a group of patients with obesity and normal glucose-tolerance, and another group of matched metformin-treated patients T2DM who underwent Endobarrier implant, demonstrated lower food intake only at one week [ 12 ].…”

Is intestinal permeability increased in obesity? A review including the effects of dietary, pharmacological and surgical interventions on permeability and the microbiome

“…[32][33][34][35] There was no change in LMR in response to obesity treatment with Endobarrier, whereas there was an improvement in insulin sensitivity and a significant reduction in body weight and fat mass. 32 In a prior study from our laboratory, we failed to see significant effects in intestinal permeability measurements using 13 C-mannitol and lactulose when comparing healthy volunteers with BMI below or above 25 kg/m 2 . 33 In patients with class III obesity, small intestinal and colonic permeability (urinary recovery of lactulose/L-rhamnose and sucralose/erythritol, respectively) were not significantly different from controls; however, gastroduodenal permeability (urinary sucrose recovery) was significantly increased in obese compared with lean controls, and this normalized following sleeve gastrectomy.…”

“…Several studies using lactulose as disaccharide and mannitol or rhamnose as monosaccharide showed no increase in small bowel or colonic permeability in overweight or obesity relative to normal control data 32‐35 . There was no change in LMR in response to obesity treatment with Endobarrier, whereas there was an improvement in insulin sensitivity and a significant reduction in body weight and fat mass 32 .…”

“…Several studies using lactulose as disaccharide and mannitol or rhamnose as monosaccharide showed no increase in small bowel or colonic permeability in overweight or obesity relative to normal control data 32‐35 . There was no change in LMR in response to obesity treatment with Endobarrier, whereas there was an improvement in insulin sensitivity and a significant reduction in body weight and fat mass 32 . In a prior study from our laboratory, we failed to see significant effects in intestinal permeability measurements using 13 C‐mannitol and lactulose when comparing healthy volunteers with BMI below or above 25 kg/m 2 33 .…”

Research Progress of Duodenal-Jejunal Bypass Liner in the Treatment of Obesity and Type 2 Diabetes Mellitus

“…Meanwhile, HbA1c in the device group and the control group decreased by 1.3% and 0.4%, respectively ( P < 0.05), and the use of hypoglycemic drugs also decreased. In addition, Obermayer et al 15 found that DJBL can improve insulin sensitivity in obese patients with T2DM.…”