A recent study estimates that 13% of Hong Kong Chinese population has abnormal blood glucose control. According to data from the Yao Chung Kit Diabetes Assessment Centre of The Chinese University of Hong Kong (CUHK), up to 50% of high risk subjects who underwent screening had either prediabetes or diabetes with high body mass index (BMI) as a major risk factor. Without proper glucose control, type 2 diabetes (T2D) can induce multiple organ dysfunctions such as impaired visual acuity, renal failure, coronary heart disease and stroke.
Apart from dietary and behavioral modifications, patients with T2D usually require oral anti-diabetic medications or insulin injection to control their blood glucose. However, insulin injection therapy may lead to common side effects like hypoglycemia and weight gain in addition to affecting patients’ daily life.
For patients with T2D and morbid obesity (BMI>35 kg/m2), bariatric surgery (such as gastric bypass, sleeve gastrectomy and gastric banding) is the most effective method to improve glucose control. In the past 8 years, Department of Surgery at CUHK has performed bariatric surgeries for 38 patients with T2D. After surgery, about two-third of them showed a significant improvement in glucose control and about half of them discontinued the use of anti-diabetic medications. Although bariatric surgery is effective, currently its use is limited to those who are morbidly obese. To further improve glucose control in patients with moderate obesity (BMI 25-35 kg/m2), CUHK has introduced a new surgical treatment for obese T2D patients with lower operative risk and less post-operative discomfort – a novel surgical device called “Gastric Contraction Modulator”.
“Gastric Contraction Modulator” is an implantable device which generates electrical pulses to stimulate the stomach muscles. This device is introduced by laparoscopic technique and works like a pacemaker. It enhances the activity of gastric muscles during a meal, which activates and modifies the nervous and hormonal signals. The stimulation causes the subject to feel full sooner, reduce food intake and thus take less food, resulting in weight loss. This is often accompanied by improvement in blood glucose levels, blood pressure and waist circumference.
Since February 2010, Department of Surgery and Department of Medicine & Therapeutic at CUHK had started a clinical trial, which aims to compare traditional insulin therapy against the use of “Gastric Contraction Modulator” implant in difficult-to-treat obese T2D patients. Instead of starting insulin injection therapy, four moderately obese patients with an average body weight of 88kg and BMI 31kg/m2 received laparoscopic implantation of this device at the Prince of Wales hospital. All patients recovered well and stayed in hospital for about 3 days after the procedure. All patients reported increased satiety and reduction in food intake. During a 3-month period, without the needs of insulin injection therapy, we observed improved glucose control with an average 1.5% reduction in HBA1c (from 9.5% to 7.9%). Other parameters such as body weight, waist circumference, blood pressure and percentage of total body fat also showed reduction after the procedure. This trial is still on-going and we aim to recruit more suitable patients (patients with moderate obesity BMI 25-35kg/m2 who suffered from diabetes for more than 2 years and still encounter difficulty in blood glucose control without insulin injection therapy )and compare its effectiveness against insulin injection therapy. With more data in the future, “Gastric contraction modulator” implantation can become an alternative treatment for glucose control in difficult-to-treat obese T2D patients.
For enquiries about the clinical trial, please contact 2632 2956 during office hours.
(From Left) Professor Alice Pik Shan KONG, Associate Professor, Department of Medicine and Therapeutics, Faculty of Medicine, CUHK; Professor Juliana Chung Ngor CHAN, Professor of Medicine and Therapeutic, Department of Medicine and Therapeutics, CUHK; Professor Enders Kwok Wai NG, Head of Division of Upper Gastrointestinal Surgery, Department of Surgery, Faculty of Medicine, CUHK; Dr. Simon Kin Hung WONG, Clinical Associate Professor (Honorary), Department of Surgery, Faculty of Medicine, CUHK and Dr. Vanessa Wan Sze NG, Clinical Tutor (Honorary), Department of Medicine and Therapeutics, Faculty of Medicine, CUHK present the study finding.
Mr. Chan demonstrates a new surgical treatment for obese T2D patients –“Gastric Contraction Modulator”.