Gastrointestinal devices for the treatment of type 2 diabetes.

BACKGROUND: Obesity and type 2 diabetes (T2D) continue to be growing epidemics worldwide. Although bariatric surgery remains the most effective and durable treatment for both of these chronic diseases, there is a need for therapies with risk and benefit profiles between medication and standard surgical procedures. Currently there are several endoscopic and minimally invasive therapies available worldwide to treat T2D.

OBJECTIVE: To review the current evidence regarding the safety and efficacy of medical devices to treat T2D.

SETTING: Academic practice, international

METHODS: The published literature was searched for articles evaluating the safety and efficacy of endoluminal and surgical devices used for the treatment of obesity and T2D.

RESULTS: The current devices in use include intragastric balloons, a duodenal-jejunal liner, gastric content aspiration, and devices that provide neuromodulation to the stomach or vagal nerves. On early phases of first-in-human studies is the duodenal mucosal resurfacing. The current evidence supporting the safety and efficacy of temporary use (6 months) for the intragastric balloon for lower body mass index (BMI) patients is strong and there is growing evidence regarding the effects of the other devices to treat T2D.

CONCLUSIONS: There is a need for novel therapies to bridge the risk and benefit gap between medical and surgical treatment of T2D. The original indication for many of the current devices was treatment of obesity. Several devices that are currently available are promising but require more study in T2D patient populations.