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IMPACT OF ENDOSCOPIC GASTRIC REMODELING ON GLYCEMIC CONTROL IN PATIENTS WITH DIABETES AND PRE-DIABETES
Ravi Teja Pasam
*1,2, Pichamol Jirapinyo
1, Christopher C. Thompson
11Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, MA; 2Wentworth-Douglass Hospital, Dover, NH
IntroductionCurrent research suggests that EGR leads to improvement in obesity related metabolic dysfunction outcomes including glycemic control, but data is limited. The objective of our study was to assess the impact of EGR on glycemic control in patients with pre-diabetes and diabetes mellitus (DM).
MethodsA prospectively collected database was retrospectively analyzed for consecutive patients who underwent an EGR procedure from September 2017 to August 2024. Patients with pre-diabetes or DM were included in the study. Demographic characteristics and data regarding hypoglycemic and anti-obesity medications were collected. Follow-up period was 12 months. The primary outcome was change in hemoglobin A1C (HbA1C). Secondary outcomes were percent total weight loss (%TWL), total weight loss of 5% or greater (5%TWL), usage of oral hypoglycemic medications and insulin use. Paired t-test and McNemar test were used to analyze the data.
ResultsA total of 117 patients were included in the study. Mean age of the cohort was 48.02 years (SD: 12.38) and 82.91% of the patients were females. Mean weight and BMI were 233.4 lbs (SD: 46.38) and 39.16 kg/m2 (SD: 7.10). While 73 patients (62.39%) were pre-diabetic, 37.61% of the patients were diabetic. Eighty-two patients (70.90%) were on anti-obesity medications during the study period. HbA1C levels before and 12 months after the procedure were available for 80 patients. There was a significant decrease in HbA1C at the end of follow-up (Mean: -0.57; SD: to 0.88; p-value = <0.0001). Mean %TWL at 6 months was 14.63% (SD: 6.93), which was sustained at 12 months (Mean %TWL:14.15%; SD: 9.09). Ninety patients (76.92%) had 5%TWL. The proportion of patients, with DM, on oral hypoglycemic medications was significantly lower at the end of follow-up compared to the time of EGR (47.73% vs 61.36% p-value = 0.01). Among patients with diabetes, there was no significant change in the proportion of patients needing insulin (15.91% vs 18.19%, p-value = 0.56). Diabetes treatment regimen was de-escalated in 25% of the patients, escalated in 1 patient and stable in the rest of the patients.
ConclusionOur study demonstrates that EGR leads to a significant improvement in HbA1C in patients with DM and pre-diabetes, and allows for de-escalation of oral hypoglycemic medications. We did not see improvement in insulin use.
Table 1. Baseline Characteristics and outcomes of patients undergoing endoscopic gastric remodeling for obesity
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