Polski
Gastric Contractility Modulation — a novel method for the treatment of type 2 diabetes mellitus and obesity
Abstract
Because the majority of antidiabetic medications are of limited efficacy and patient compliance with treatment is usually poor, new therapies are still being searched for. In the review a newly developed system for treatment of subjects with type 2 diabetes and concomitant overweight/obesity is described.
The system consists of an implantable pulse generator that delivers electrical stimuli through leads implanted in the sero-muscular layer of the stomach. The device recognises and automatically modulates natural electrical activity of the stomach during meals, strengthening gastric contractility. This increase in the force of contractions enhances vagal afferent activity. Modulated signals are transmitted to the regulatory centres in the brain in order to provoke an early response of the gut typical of a full meal. Clinical trials performed to date show that the system improves glycaemic control with minimal patient compliance needed and with added benefits of body weight loss, a decrease in blood pressure, and favourable changes in the lipid profile. The system is safe, well-tolerated, with a low risk of hypoglycaemia, and will probably become an alternative to the use of incretins or to bariatric surgery in obese patients who are unwilling to undergo a major and anatomically irreversible operation.
Keywords: interventional diabetologygastric electrical stimulationtype 2 diabetesobesityappetite regulation
References
- World Health Organization 2008. Global strategy on diet, physical activity and health. www.who.diet.int/dietphysicalactivity/publications/facts/obesity/en.
- James WPT. The epidemiology of obesity: the size of the problem. J Intern Med. 2008; 263(4): 336–352.
- Ogden CL, Carroll MD, McDowell MA, et al. Obesity among adults in the United States--no statistically significant change since 2003-2004. NCHS Data Brief. 2007(1): 1–8.
- World Health Organization 2011 World Health Organization: diabetes facts sheet. http://www.who.int/mediacentre/factsheets/fs312/en/index.html.
- Centers for Disease Control and Prevention. 2012 Diabetes data and trends. Data from the National Health Interview Survey. Statistical analysis by the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation. http://www.cdc.gov/diabetes/ststistics/pre/national/figage.html.
- Laakso M, Lehto S. Epidemiology of risk factors for cardiovascular disease in diabetes and impaired glucose tolerance. Atherosclerosis. 1998; 137: S65–S73.
- Holman RR, Paul SK, Bethel MA, et al. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131): 837–853.
- Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998; 352(9131): 854–865.
- National Center for Health Statistics. Prevelance of overweight among children and adolescents: United States. www.cdc.gov/nchs/products/pubs/pubd/hestats/overwght99.htm (1992-2002).
- Woods SC, D'Alessio DA. Central control of body weight and appetite. J Clin Endocrinol Metab. 2008; 93(11 Suppl 1): S37–S50.
- Moran TH. Gut peptides in the control of food intake. Int J Obes (Lond). 2009; 33 Suppl 1: S7–10.
- Wang PYT, Caspi L, Lam CKL, et al. Upper intestinal lipids trigger a gut-brain-liver axis to regulate glucose production. Nature. 2008; 452(7190): 1012–1016.
- Kentish S, Li H, Philp LK, et al. Diet-induced adaptation of vagal afferent function. J Physiol. 2012; 590(1): 209–221.
- Peles S, Petersen J, Aviv R, et al. Enhancement of antral contractions and vagal afferent signaling with synchronized electrical stimulation. Am J Physiol Gastrointest Liver Physiol. 2003; 285(3): G577–G585.
- Sanmiguel CP, Aviv R, Policker S, et al. Association between gastric electromechanical activity and satiation in dogs. Obesity (Silver Spring). 2007; 15(12): 2958–2963.
- Pocai A, Lam TKT, Gutierrez-Juarez R, et al. Hypothalamic K(ATP) channels control hepatic glucose production. Nature. 2005; 434(7036): 1026–1031.
- Libert C. Inflammation: A nervous connection. Nature. 2003; 421(6921): 328–329.
- Aviv R, Sanmiguel CP, Kliger A, et al. The use of gastric electrical signals for algorithm for automatic eating detection in dogs. Neurogastroenterol Motil. 2008; 20(4): 369–376.
- Bohdjalian A, Prager G, Aviv R, et al. One-year experience with Tantalus: a new surgical approach to treat morbid obesity. Obes Surg. 2006; 16(5): 627–634.
- Sanmiguel CP, Haddad W, Aviv R, et al. The TANTALUS system for obesity: effect on gastric emptying of solids and ghrelin plasma levels. Obes Surg. 2007; 17(11): 1503–1509.
- Policker S, Lu H, Haddad W, et al. Electrical stimulation of the gut for the treatment of type 2 diabetes: the role of automatic eating detection. J Diabetes Sci Technol. 2008; 2(5): 906–912.
- Sanmiguel CP, Conklin JL, Cunneen SA, et al. Gastric electrical stimulation with the TANTALUS System in obese type 2 diabetes patients: effect on weight and glycemic control. J Diabetes Sci Technol. 2009; 3(4): 964–970.
- Bohdjalian A, Prager G, Rosak C, et al. Improvement in glycemic control in morbidly obese type 2 diabetic subjects by gastric stimulation. Obes Surg. 2009; 19(9): 1221–1227.
- Bohdjalian A, Ludvik B, Guerci B, et al. Improvement in glycemic control by gastric electrical stimulation (TANTALUS) in overweight subjects with type 2 diabetes. Surg Endosc. 2009; 23(9): 1955–1960.
- Policker S, Haddad W, Yaniv I. Treatment of type 2 diabetes using meal-triggered gastric electrical stimulation. Isr Med Assoc J. 2009; 11(4): 206–208.
- Wong SKH, Kong APS, Luk AOY, et al. A pilot study to compare meal-triggered gastric electrical stimulation and insulin treatment in Chinese obese type 2 diabetes. Diabetes Technol Ther. 2015; 17(4): 283–290.
- Lebovitz HE, Ludvik B, Kozakowski J, et al. Gastric electrical stimulation treatment of type 2 diabetes: effects of implantation versus meal-mediated stimulation. A randomized blinded cross-over trial. Physiol Rep. 2015; 3(7).
- Liu S, Lei Y, Chen JDZ. Inhibitory effects and mechanisms of colonic electric stimulation on gastric and rectal tone in conscious dogs. Dis Colon Rectum. 2006; 49(11): 1749–1754.
- Gerstein HC, Miller ME, Byington RP, et al. Action to Control Cardiovascular Risk in Diabetes Study Group. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008; 358(24): 2545–2559.
- Lebovitz HE, Ludvik B, Yaniv I, et al. Metacure Investigator Group. Fasting plasma triglycerides predict the glycaemic response to treatment of type 2 diabetes by gastric electrical stimulation. A novel lipotoxicity paradigm. Diabet Med. 2013; 30(6): 687–693.
- Wang GJ, Tomasi D, Backus W, et al. Gastric distention activates satiety circuitry in the human brain. Neuroimage. 2008; 39(4): 1824–1831.
- Lam TKT. Neuronal regulation of homeostasis by nutrient sensing. Nat Med. 2009; 10: 99–10.
