Temporary gut liner alternative to weight loss surgery shows sustained benefits for people with type 2 diabetes and obesity

New research presented today at the Diabetes UK Professional Conference 2024 reveals that the positive effects on weight loss and type 2 diabetes management of EndoBarrier treatment were sustained in most people two years after they had the device removed.

EndoBarrier Treatment is a minimally invasive and non-permanent alternative to other methods of weight loss (bariatric) surgery.

A range of treatment options are available for people with type 2 diabetes to manage blood sugar levels.

This includes support to make changes to diet and physical activity, medications such as metformin and insulin, and bariatric surgery.

Approximately 90 per cent of adults with type 2 diabetes live with overweight or obesity. Weight loss helps to lower blood sugar levels and reduce the risk of serious diabetes complications, but even with professional support losing weight and keeping it off is difficult for many.

Weight loss surgery is available for some people with obesity and type 2 diabetes and can be very effective in managing both conditions.

Unlike permanent and more invasive weight loss surgeries, the EndoBarrier device is reversible and fitted with a straightforward procedure.

The thin impermeable sleeve, inserted via the mouth, lines the first 60cm of the small intestine, preventing food absorption in that area.

This is thought to change how the body metabolises nutrients and releases gut hormones, resulting in more efficient processing of glucose and individuals feeling fuller more quickly. The EndoBarrier is removed via the mouth after 12 months.

Dr Bob Ryder, Consultant Diabetologist at Birmingham City Hospital, and lead researcher on the study, presented outcomes for the 90 people with type 2 diabetes and obesity who had received the EndoBarrier treatment, including, for the first time, outcomes for the 60 who had attended the follow up evaluation two years after removal of the device.

At around 12 months following EndoBarrier implantation, the 60 participants experienced substantial weight loss (average 16.7kg) and significantly lower blood sugar, blood pressure and cholesterol levels.

Two years after EndoBarrier removal, 32/60 (53 per cent) of people were found to sustain their bodyweight and blood sugar level improvements, 16/60 (27 per cent) partially-sustained the improvements and 12/60 (20 per cent) reverted to baseline.

Of the 36/60 people who were using insulin prior to EndoBarrier treatment, 10 (27.8 per cent) were no longer using insulin at two years post removal.

A total of 13 of the original 90 people required early EndoBarrier removal due to complications, all of whom made a full recovery.

A combination of lower blood sugar levels and lower body weight can bring significant health benefits to people with type 2 diabetes.

The latest EndoBarrier results indicate that the device could be another treatment option for people with type 2 diabetes and obesity, but more data is needed to thoroughly assess benefits against risks.

To facilitate this, a worldwide EndoBarrier registry has been established under the auspices of the Association of British Clinical Diabetologists (ABCD).

Dr Ryder said: “There is a worldwide pandemic of type 2 diabetes and obesity, and many people are not able to keep weight off and have blood sugar levels that are too high despite their best efforts and all available medications.

“For them, bariatric surgery can be effective, but demand is too great for available services and the surgery is permanent and not without risk.”

He added: “EndoBarrier has the advantage of being a relatively easy treatment to give, and it is not permanent as the device is removed after about a year.

“The importance of our findings to people living with type 2 diabetes is that we have shown that in our service 80 per cent were able to maintain significant improvement 2 years after removal of EndoBarrier.”

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said: “Despite notable advances in treatment options for type 2 diabetes over the past decade, bringing blood sugars into target range and keeping them there can still be a real challenge.

“Healthcare professionals must work with people with type 2 diabetes to find the right approach for them, whether that involves medications, diet and exercise, or weight loss surgery.”

She concluded: “More type 2 treatments will mean that people with the condition will have a better opportunity of finding a treatment that suits them, so they have the best chance of a long and healthy future.”