University of Kansas Medical Center Kansas City, MO
Raj Shah, MD1, Thomas J.. Mathews, MD2, Pichamol Jirapinyo, MD, MPH3, Christopher C.. Thompson, MD, MSc, FACG3 1Brigham and Women's Hospital, Boston, MA; 2University of Kansas Medical Center, Kansas City, MO; 3Brigham and Women's Hospital, Boston, MA
Introduction: Without intervention, 25% of patients with pre-diabetes (pre-DM) will progress to diabetes in 3-5 years. Reversing pre-DM has both economic and cardiac benefits. Weight loss is a cornerstone therapy for reversing pre-DM. Endoscopic bariatric and metabolic therapies such as endoscopic sleeve gastroplasty (ESG) is effective for weight loss, however it is less clear whether these therapies can reverse prediabetes and prevent diabetes onset.
Methods: We conducted a retrospective study at a tertiary center including patients who underwent ESG between September 2017 to July 2022. Consecutive patients were included if they met criteria for pre-DM, hemoglobin A1c (HbA1c) 5.7%-6.4%, within one year prior to their procedure. Patients with current or prior HbA1c >6.4% or a diagnosis of diabetes were excluded. Demographics, dichotomous and continuous outcomes for pre-diabetes and HbA1c were collected. Mean difference (MD) and averages were calculated.
Results: Twenty-eight patients met inclusion criteria for pre-DM and underwent ESG. Demographics are in Table 1. 83.3% of patients had complete resolution of prediabetes at 6 months post intervention, 85.7% at 12 months, and 82.1% of all patients had resolution during the 3 to 12 month follow-up (Figure 1).
At 6 months mean Hb A1c decreased from 5.9% to 5.4% MD = 0.46%, at 12 months from 5.8% to 5.5% (MD = 0.39%), and from 5.9% to 5.4% (MD = 0.5%) overall in the 3 to 12 months after intervention. In this study, all 28 patients with pre-DM who underwent ESG had an improvement in their A1c with none progressing to diabetes.
81% of those who underwent ESG with plication technique (17/21) and 86% of those with suturing technique (6/7) achieved resolution of pre-DM in 3 to 12 months. 44% (8/18) of those on a weight loss or diabetes medication (GLP-1 agonist or metformin) stopped these medications within a year. Average total weight loss at 6 months was 14.3%. 10 patients did not have concomitant weight loss medications and only underwent ESG. 90% of these patients (9/10) had reversal of pre-diabetes with a mean HbA1c decrease from 5.92% to 5.47% (MD = 0.46%).
Discussion: Endoscopic sleeve gastroplasty, via plication or suturing, appears to be a viable treatment option for pre-DM and may be able to prevent the onset of diabetes. Additionally, this intervention may help minimize pharmacotherapy in those with pre-DM.
Figure: Resolution of prediabetes after endoscopic sleeve gastroplasty
Disclosures:
Raj Shah indicated no relevant financial relationships.
Thomas Mathews indicated no relevant financial relationships.
Pichamol Jirapinyo: Apollo Endosurgery – Consultant, Grant/Research Support. Boston Scientific – Grant/Research Support. Endosim – Royalties. ERBE – Consultant. Fractyl – Grant/Research Support. GI Dynamics – Consultant, Grant/Research Support. Spatz – Consultant. USGI Medical – Grant/Research Support.
