title: Endobarrier® in Grade I Obese Patients with Long-Standing Type 2 Diabetes: Role of Gastrointestinal Hormones in Glucose Metabolism.
abstract: The purpose of this study was to evaluate the efficacy and safety of Endobarrier® in grade 1 obese T2DM patients with poor metabolic control and the role of gastro-intestinal hormone changes on the metabolic outcomes.
  
  
  
  Twenty-one patients aged 54.1 ± 9.5 years, diabetes duration 14.8 ± 8.5 years, BMI 33.4 ± 1.9 kg/m2, and HbA1c 9.1 ± 1.3 %, under insulin therapy, were implanted with Endobarrier®. Fasting concentrations of PYY, ghrelin and glucagon, and AUC for GLP-1 after a standard meal test were determined prior to and at months 1 and 12 after implantation.
  
  
  
  Patients lost 14.9 ± 5.7 % of their total body weight. HbA1c decreased 1.3 % in the first month, but at the end of the study, the reduction was 0.6 %. HbA1c ≤ 7 % was achieved in 26.3 % of patients. No differences in GLP-1 AUC values were found before and after implant. Fasting plasma ghrelin and PYY concentrations increased from month 1 to 12. Conversely, fasting plasma glucagon concentrations decreased at month 1 and increased thereafter. Weight (β 0.152) and HbA1c decrease at month 1 (β 0.176) were the only variables predictive of HbA1c values at 12 months (adjusted R2for the model 0.693, p = 0.001). Minor adverse events occurred in 14 % of patients and major events in 9.5 %.
  
  
  
  Endobarrier® in T2DM patients with grade I obesity and poor metabolic control is associated with significant weight decrease and moderate reduction in HbA1c at month 12. Our data do not support a role for GLP-1 in the metabolic improvement in this subset of patients.
authors.affiliation: Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, c/ Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain. nuriavilarrasa@yahoo.es.|CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain. nuriavilarrasa@yahoo.es.
authors.forename: Nuria
authors.identifier: 0000-0003-3188-1990
authors.initials: N
authors.lastname: Vilarrasa
authors.affiliation: Bariatric Surgery Unit, Hospital Universitario de Bellvitge-IDIBELL, c/ Feixa Llarga s/n 08907, LHospitalet de Llobregat, Barcelona, Spain.
authors.forename: Amador García Ruiz
authors.initials: AG
authors.lastname: de Gordejuela
authors.affiliation: Bariatric Surgery Unit, Hospital Universitario de Bellvitge-IDIBELL, c/ Feixa Llarga s/n 08907, LHospitalet de Llobregat, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Casajoana
authors.affiliation: Hospital Universitari de Tarragona Joan XXIII, Institut Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, 43007, Tarragona, Spain.
authors.forename: Xevi
authors.initials: X
authors.lastname: Duran
authors.affiliation: Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, c/ Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: Toro
authors.affiliation: Unit of Endoscopy Gastrodex, Hospital Universitario Dexeus, Sabino Arana, 5-19, 08028, Barcelona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Espinet
authors.affiliation: Unit of Endoscopy. Gastro-obeso Center, Rua Barata Ribeiro, 237, Sao Paulo, SP, 01308-000, Brazil.
authors.forename: Manoel
authors.initials: M
authors.lastname: Galvao
authors.affiliation: CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain.|Hospital Universitari de Tarragona Joan XXIII, Institut Investigació Sanitaria Pere Virgili, Universitat Rovira i Virgili, 43007, Tarragona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Vendrell
authors.affiliation: Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, c/ Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: López-Urdiales
authors.affiliation: Department of Endocrinology and Nutrition, Hospital Universitario de Bellvitge-IDIBELL, c/ Feixa Llarga s/n 08907, L'Hospitalet de Llobregat, Barcelona, Spain.|CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Pérez
authors.affiliation: Bariatric Surgery Unit, Hospital Universitario de Bellvitge-IDIBELL, c/ Feixa Llarga s/n 08907, LHospitalet de Llobregat, Barcelona, Spain. jpujol@bellvitgehospital.cat.
authors.forename: Jordi
authors.initials: J
authors.lastname: Pujol
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000295:instrumentation* / Q000379:methods*; D001786:Blood Glucose / Q000378:metabolism; D020878:Device Removal; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005768:Gastrointestinal Hormones / Q000378:metabolism / Q000502:physiology*; D054439:Ghrelin / Q000097:blood; D005934:Glucagon / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood; D005947:Glucose / Q000378:metabolism*; D006801:Humans; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000150:complications / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D019919:Prosthesis Implantation
chemical_list: D001786:Blood Glucose; D005768:Gastrointestinal Hormones; D054439:Ghrelin; D007328:Insulin; D052216:Glucagon-Like Peptide 1; D005934:Glucagon; D005947:Glucose
keywords: Duodenal jejunal bypass liner; Endobarrier; Gastrointestinal hormones; Ghrelin; Glucagon; Glucagon-like; Grade I obese patients; Peptide 1; Peptide YY; Type 2 diabetes