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Kalapala_ABE_AnnualCourse2021_Diabetes-Epidemic

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AIG Hospitals in Hyderabad, India is addressing the diabetes epidemic through the use of small bowel-based metabolic devices. These devices work by modifying the metabolic pathway and have shown positive effects on diabetes control. However, there are currently no FDA-approved devices for interventions on the small bowel.<br /><br />The metabolic mode of action of these devices involves channeling food through the small intestine without contacting the intestinal wall, which leads to increased metabolic rate, reduced insulin resistance, and earlier satiety. Clinical studies have demonstrated reductions in fasting blood glucose, fasting insulin, and HbA1c levels in patients with diabetes who underwent these interventions.<br /><br />One such device, the EndoBarrier, showed promising results in initial studies but had to halt its FDA trial due to safety concerns, including a high rate of liver abscess and bacterial translocation. A next-generation solution called the EndoSleeve has advantages over the EndoBarrier and has regulatory approvals in international markets, with reimbursement in Germany and the UK starting in 2018.<br /><br />Other anchoring methodologies for duodenal-jejunal bypass liners have been explored, including barbs penetrating the duodenal bulb and using net shape across the pylorus. Distal migration, a potential complication of these devices, can be caused by the variability of the size of the aperture and distensibility of the pylorus.<br /><br />Another approach being explored is endolumenal magnets that form a bypass of the GI tract, allowing for the natural expulsion of the magnets without the need for implantation.<br /><br />Other procedures discussed include endoscopic dual-path enteral anastomosis using self-assembling magnets, duodenal mucosal resurfacing, and pyloric balloon dilation.<br /><br />Clinical studies have shown the dual efficacy effect of these small bowel-based interventions leads to weight loss and improvements in glycemic control and cardio-metabolic parameters.<br /><br />In conclusion, small bowel-based metabolic devices show promising potential for addressing the diabetes epidemic, although further research and development are needed to ensure their safety and efficacy.

Keywords

AIG Hospitals

Hyderabad

India

diabetes epidemic

small bowel-based metabolic devices

EndoBarrier

EndoSleeve

duodenal-jejunal bypass liners

endolumenal magnets

weight loss