UK’s first NHS service of new intestinal tube used to treat Type 2 diabetes and obesity

EndoBarrier Therapy for T2 Diabetes & Obesity

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An NHS service in Birmingham is offering an alternative treatment to gastric bypass for obese people with Type 2 diabetes that could be made widely available, according to new data¹ being presented at Diabetes UK's Professional Conference 2017 by a team from City Hospital in Birmingham.

The charity says more needs to be done to tackle the diabetes crisis in the UK, including investing more in research and improving healthcare and treatment to prevent yet more people developing this potentially life-threatening condition.

Previous studies² indicate that an EndoBarrier - a 60cm long 'sleeve' inserted into the intestines to stop food being absorbed – can be a helpful therapy for overweight people with Type 2 diabetes. The Birmingham team tested offering it within an NHS service.

The service was set up in October 2014 for people with Type 2 diabetes and obesity who were having difficulties managing their condition. Of the 45 people referred for treatment, 25 went on to have an EndoBarrier inserted. Participants had lived with Type 2 diabetes for an average of 12 years and usual treatments options, including diet and Type 2 medications, had failed to control it; 15 were using insulin therapy.

One year later, the researchers found that participants had lost a significant amount of weight (over 15 kilos), had reduced systolic blood pressure and much better controlled blood glucose levels. Six participants also no longer needed to use insulin therapy.

The lead clinician, Dr Robert Ryder, said:

"As other studies have shown promising results of EndoBarriers being used to treat Type 2 diabetes effectively, we wanted to find out if offering a service on the NHS would help some of the hardest cases. We believe this to be an effective and safe service, and one NHS hospitals across the UK could easily take it up."

Diabetes UK Director of Research, Dr Elizabeth Robertson, said:

"People with diabetes face the risk of life-changing, and life-limiting, complications, unless they are given the very best care and the support they need to manage their condition well. The results of this trial are promising, but long-term, large-scale studies are still needed to understand the true impact of EndoBarrier use on the management of Type 2 diabetes."

For every £1 spent on diabetes care, only 0.5p is spent on research. Around £60 million is spent on diabetes research in the UK, compared to £500 million on cancer research. This is holding back progress on better care and treatment or finding a cure.

The Diabetes UK Professional Conference 2017 is being held 8-10 March at Manchester Central Convention Complex, Manchester. The world-class conference is run exclusively for healthcare professionals and scientists working in the field of diabetes and is one of the largest healthcare conferences in the UK.

Chair of NHS Sandwell and West Birmingham CCG, Prof Nick Harding OBE said:

'We are delighted to see this service being offered at Birmingham City Hospital. It's good to see the promising results of EndoBarriers for obese people with Type 2 diabetes, with participants in the study losing weight and enjoying better health. This is a great example of innovation being used to improve quality of life for our patients. '

Further research information:

At the one-year follow-up, participants had lost an average of 16.3 kilos (+/-10) and systolic blood pressure fell significantly (from 137.7 (+/-13.5) to 126.0 (+/-16.5) mm Hg). Blood glucose levels were better controlled, with HbA1c falling from an average of 81.2 (+/-24.7) to 56.4 (+/-11.5) mmol/mol, and six people no longer needed insulin therapy.

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1. Abstract: (A26) One year efficacy, safety and tolerability outcomes of endoscopic proximal intestinal exclusion therapy using the Endobarrier device: Institution of the UK's first National Health Service Endobarrier service for Type 2 diabetes and obesity (Young Diabetologist and Endocrinologist Travel Award session; Charter 2; Wednesday 16:10-17:10).
2. Publication: Petra Kaválková, Miloš Mráz, Pavel Trachta, Jana Kloučková, Anna Cinkajzlová, Zdeňka Lacinová, Denisa Haluzíková, Marek Beneš, Zuzana Vlasáková, Václav Burda, Daniel Novák, Tomáš Petr, Libor Vítek, Terezie Pelikánová, and Martin Haluzík, Endocrine effects of duodenal–jejunal exclusion in obese patients with type 2 diabetes mellitus, Journal of Endocrinology 231(1):11-22.

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