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A pilot study to compare meal-triggered gastric electrical stimulation and insulin treatment in Chinese obese type 2 diabetes.

ABSTRACT: Gastrointestinal electromodulation therapy is a novel alternative for achieving diabetes control without traditional bariatric surgery. We compared the efficacy of a meal-initiated implantable gastric contractility modulation (GCM) device with that of insulin therapy in obese Chinese type 2 diabetes (T2D) patients, for whom oral antidiabetes drugs (OADs) had failed.Sixteen obese (body mass index, 27.5-40.0?kg/m(2)) T2D patients with a glycated hemoglobin (HbA1c) level of >7.5% on maximal doses of two or more OADs were offered either insulin therapy (n=8) or laparoscopic implantation of a GCM (n=8). We compared changes in body weight, waist circumference (WC), and HbA1c level 1 year after surgery.The GCM and insulin groups had similar baseline body weight and HbA1c. At 12 months, body weight (-3.2±5.2?kg, P=0.043) and WC (-3.8±4.5?cm, P=0.021) fell in the GCM group but not in the insulin group (P<0.05 for between-group difference). At 6 and 12 months, the HbA1c level fell by 1.6±1.1% and 0.9±1.6% (P=0.011), compared with 0.6±0.3% and 0.6±0.3% (P=0.08) for the insulin group (P=0.15 for between-group difference). The mean 24-h systolic blood pressure (BP) fell by 4.5±1.0?mm Hg in the GCM group (P=0.017) but not in the insulin group. The GCM group required fewer antidiabetes medications (P<0.05) and BP-lowering drugs (P<0.05) than the insulin group. A subgroup analysis showed that patients with a triglyceride level of <1.7?mmol/L had a tendency toward a lower HbA1c level (P=0.090) compared with the controls.In obese T2D patients for whom OADs had failed, GCM implantation was a well-tolerated alternative to insulin therapy, with a low triglyceride level as a possible predictor for glycemic response.

SUBMITTER: Wong SK

PROVIDER: S-EPMC4365444 | biostudies-literature | 2015 Apr

REPOSITORIES: biostudies-literature

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A pilot study to compare meal-triggered gastric electrical stimulation and insulin treatment in Chinese obese type 2 diabetes.

Wong Simon Kin-Hung SK Kong Alice Pik-Shan AP Luk Andrea On-Yan AO Ozaki Risa R Ng Vanessa Wan-Sze VW Lebovitz Harold E HE Ng Enders Kwok-Wai EK Chan Juliana Chung-Ngor JC

Diabetes technology & therapeutics 20150224 4

<h4>Background</h4>Gastrointestinal electromodulation therapy is a novel alternative for achieving diabetes control without traditional bariatric surgery. We compared the efficacy of a meal-initiated implantable gastric contractility modulation (GCM) device with that of insulin therapy in obese Chinese type 2 diabetes (T2D) patients, for whom oral antidiabetes drugs (OADs) had failed.<h4>Patients and methods</h4>Sixteen obese (body mass index, 27.5-40.0 kg/m(2)) T2D patients with a glycated hemo ...[more]

PMID: 25710812

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Project description:BACKGROUND:Inadequate quadriceps strength following anterior cruciate ligament reconstruction (ACLR) often results in alterations in gait pattern that are usually reported during loading response. Neuro-muscular electrical stimulation (NMES) is frequently used to overcome this quadriceps weakness. Despite the beneficial effects of NMES, persistent deficits in strength and gait are reported. The aim of this study was to investigate the feasibility of applying quadriceps functional electrical stimulation (FES) during walking in addition to standard rehabilitation, in the initial stage of ACLR rehabilitation. METHODS:Subjects were randomized to quadriceps FES synchronized with walking group (n =?10) or quadriceps NMES (duty cycle of 10?s on/10?s off) group (n =?13). Both interventions were performed for 10?min three days a week, in addition to a standard rehabilitation program. Assessments were performed up to 2?weeks before the ACLR (pre-ACLR), and 4?weeks postoperatively. Outcomes measured were gait speed, single limb stance gait symmetry, quadriceps isometric peak strength ratio (peak strength at 4?weeks/peak strength pre-ACLR) and peak strength inter-limb symmetry. Gait outcomes were also assessed 1-week post-surgery. RESULTS:Subjects in both groups regained pre-ACLR gait speed and symmetry after 4?weeks of rehabilitation, with no difference between groups. However, although pre-ACLR quadriceps peak strength was similar between groups (FES - 205?Nm, NMES -?225?Nm, p =?0.605), subjects in the FES group regained 82% of their pre-quadriceps strength compared to 47% in the NMES group (p =?0.02). In addition, after 4?weeks, the FES group had significantly better inter-limb strength symmetry 0.63?±?0.15 vs. 0.39?±?0.18 in the NMES group (p =?0.01). CONCLUSIONS:Quadriceps FES combined with traditional rehabilitation is a feasible, early intervention treatment option, post-ACLR. Furthermore, at 4?weeks post-surgery, FES was more effective in recovering quadriceps muscle strength than was NMES. While spatiotemporal gait parameters did not differ between groups, kinetic and kinematic studies may be useful to further understand the effects of quadriceps FES post-ACLR. The promising results of this preliminary investigation suggest that such studies are warranted. TRIAL REGISTRATION:ISRCTN 02817399 . First posted June 29, 2016.

Dataset Information

A pilot study to compare meal-triggered gastric electrical stimulation and insulin treatment in Chinese obese type 2 diabetes.

Publications

A pilot study to compare meal-triggered gastric electrical stimulation and insulin treatment in Chinese obese type 2 diabetes.

Similar Datasets

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