Baseline Glycated Hemoglobin Levels Predict Endobarrier-Induced Weight Loss in Morbidly Obese Patients With and Without Type 2 Diabetes

Rodrigo Munoz, MD, PhD, Angelica Dominguez, Statistician, Cesar Munoz, MD, Milenko Slako, MD, Dannae Turiel, RN, Cecilia Gomez, RN, Fernando Munoz, MD, Fernando Pimentel, MD, Alan Sharp, MD, Alex Escalona, MD

DEPARTAMENTO DE CIRUGIA DIGESTIVA, ESCUELA DE MEDICINA PONTIFICIA UNIVERSIDAD CATOLICA DE CHILE

INTRODUCTION: Endoscopic treatment with the Endobarrier has shown to induce significant weight loss in morbidly obese patients. Twelve months after Endobarrier implantation, patients lose an average of 47% Excess Body Weight (%EBW). As with the weight loss seen with bariatric surgery, this weight loss is somewhat variable. We sought to identify clinical predictors of weight loss in morbidly obese patients treated with the Endobarrier for one year.

METHODS AND PROCEDURES: We reviewed charts from 61 consecutive patients implanted with the Endobarrier for 12 months. Patient demographics along with baseline comorbidities, anthropometrics and biochemical variables were selected for univariate and multivariate analysis.

RESULTS: Preoperative age and body mass index (BMI) were 35.4±9.7 years and 43±5.6 kg/m2, respectively with 44 (72%) women. In this series, 21 patients (34%) had Type 2 Diabetes Mellitus (T2DM). Twelve months after Endobarrier treatment, patients had an average %EBWL of 46±18%. Univariate analysis identified that fasting glycemia (r2 = -0.303, p<0.013), insulin-resistance determined by HOMA (HOMA-IR) (r2 = -0.457, p<0.019), and glycated hemoglobin A1c (HbA1c) (r2 = -0.471, p<0.013) were inversely associated with %EBWL at one year. In this cohort of patients the multivariate analysis indicated that only baseline Hb1Ac levels were inversely associated with %EBWL after one year of treatment (β adjusted coefficient -0.758, p <0.016). Importantly, no differences in %EBWL at one year were observed between patients with and without T2DM (%EBWL with T2DM 46.7±20% versus without T2DM 46.8±18.6%, p=0.988).

CONCLUSIONS: The results of this study indicate that higher baseline HbA1c levels are independently associated with diminished body weight loss in morbidly obese patients treated with the Endobarrier independent of the diabetic status of the patient. This finding contrasts with previous reports in which T2DM patients experienced a lower weight loss. These results show that Endobarrier induces a significant weight loss in both T2DM and non-T2DM patients.

Session: Podium Presentation

Program Number: S008