Introduction New, effective treatments are needed urgently to combat the global diabesity pandemic. Our institution led a UK multicentre randomised controlled trial (REVISE-Diabesity ISRCTN00151053) investigating the efficacy, safety and tolerability of adding Endobarrier therapy, a 60 cm endoscopically implanted proximal intestinal liner, to (GLP-1RA) drug therapy. Based on experience acquired, we instituted an NHS Endobarrier service for patients with suboptimally controlled type 2 diabetes and obesity.
Method We initiated an NHS Endobarrier service for patients with sub-optimally controlled type 2 diabetes and obesity.
Results Since October 2014 there have been 118 referrals (46 accepted, 18 awaiting assessment, 54 excluded). 25 have completed 1 year’s implant (aged 51.9±7.5 years, 56.0% male, 44.0% Caucasian, diabetes duration 12.0 (8.5–21.0) years, 60.0% insulin-treated, BMI 41.1±8.9 kg/m2) – see Table for 12m results.
12 have completed 6m post Endobarrier removal - see Graphs. Insulin dose significantly fell; rises in mean HbA1c, weight and BMI were not statistically significant and all remained considerably lower than baseline. 9 pts sustained their reductions in wt and HbA1c, reporting considerable improvements in wellbeing, energy, fitness, exercise ability. Overall there were 3 (7.5%) serious device-related adverse events (2 gastrointestinal bleeds, 1 liver abscess) resulting in early removal with resolution of the event in all cases. 95% of patients were “Extremely likely” to recommend Endobarrier treatment to friends and family (NHS F and FT).
Conclusion This inaugural NHS service demonstrates Endobarrier to be highly effective in selected, carefully monitored patients with refractory diabesity, with high patient satisfaction levels and an acceptable safety profile.
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