title: A pilot study to compare meal-triggered gastric electrical stimulation and insulin treatment in Chinese obese type 2 diabetes.
abstract: BACKGROUND
  Gastrointestinal electromodulation therapy is a novel alternative for achieving diabetes control without traditional bariatric surgery. We compared the efficacy of a meal-initiated implantable gastric contractility modulation (GCM) device with that of insulin therapy in obese Chinese type 2 diabetes (T2D) patients, for whom oral antidiabetes drugs (OADs) had failed.
  
  
  METHODS
  Sixteen obese (body mass index, 27.5-40.0 kg/m(2)) T2D patients with a glycated hemoglobin (HbA1c) level of >7.5% on maximal doses of two or more OADs were offered either insulin therapy (n=8) or laparoscopic implantation of a GCM (n=8). We compared changes in body weight, waist circumference (WC), and HbA1c level 1 year after surgery.
  
  
  RESULTS
  The GCM and insulin groups had similar baseline body weight and HbA1c. At 12 months, body weight (-3.2±5.2 kg, P=0.043) and WC (-3.8±4.5 cm, P=0.021) fell in the GCM group but not in the insulin group (P<0.05 for between-group difference). At 6 and 12 months, the HbA1c level fell by 1.6±1.1% and 0.9±1.6% (P=0.011), compared with 0.6±0.3% and 0.6±0.3% (P=0.08) for the insulin group (P=0.15 for between-group difference). The mean 24-h systolic blood pressure (BP) fell by 4.5±1.0 mm Hg in the GCM group (P=0.017) but not in the insulin group. The GCM group required fewer antidiabetes medications (P<0.05) and BP-lowering drugs (P<0.05) than the insulin group. A subgroup analysis showed that patients with a triglyceride level of <1.7 mmol/L had a tendency toward a lower HbA1c level (P=0.090) compared with the controls.
  
  
  CONCLUSIONS
  In obese T2D patients for whom OADs had failed, GCM implantation was a well-tolerated alternative to insulin therapy, with a low triglyceride level as a possible predictor for glycemic response.
authors.affiliation: 1 Department of Surgery, Faculty of Medicine, The Chinese University of Hong Kong , The Prince of Wales Hospital, Hong Kong Special Administrative Region, China .
authors.forename: Simon Kin-Hung
authors.initials: SK
authors.lastname: Wong
authors.forename: Alice Pik-Shan
authors.initials: AP
authors.lastname: Kong
authors.forename: Andrea On-Yan
authors.initials: AO
authors.lastname: Luk
authors.forename: Risa
authors.initials: R
authors.lastname: Ozaki
authors.forename: Vanessa Wan-Sze
authors.initials: VW
authors.lastname: Ng
authors.forename: Harold E
authors.initials: HE
authors.lastname: Lebovitz
authors.forename: Enders Kwok-Wai
authors.initials: EK
authors.lastname: Ng
authors.forename: Juliana Chung-Ngor
authors.initials: JC
authors.lastname: Chan
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001794:Blood Pressure / Q000187:drug effects; D001835:Body Weight / Q000187:drug effects; D002681:China; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D004599:Electric Stimulation Therapy / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects; D006442:Glycated Hemoglobin / Q000187:drug effects; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D015918:Infusion Pumps, Implantable; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D062407:Meals; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000628:therapy*; D010865:Pilot Projects; D013270:Stomach / Q000502:physiology*; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference / Q000187:drug effects; D015431:Weight Loss
chemical_list: D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D014280:Triglycerides; C517652:hemoglobin A1c protein, human