New diabetes 'reversal' procedure available in the UAE from 2018

EndoBarrier, offering a cheaper and more reliable alternative to bariatric surgery, will be available at King’s College Hospital from January

EndoBarrier mimics traditional bariatric surgery without the need to undergo an extreme surgery or the expense. AFP PHOTO / LUIS ROBAYO

New weapons to help reverse diabetes and offer patients less invasive alternatives to weight loss surgery will soon be at the disposal of doctors in the UAE.

While the trend for obese patients opting for extreme bariatric surgery continues in the Emirates, those operations can be expensive and have lengthy recovery periods; however, a new day procedure under general anaesthetic – available at King’s College Hospital from January – could help patients reverse diabetes and the first patients are currently being screened for suitability.

The EndoBarrier procedure involves doctors inserting a flexible tube through the throat and around the patient’s duodenum, the first segment of the small intestine. It helps alter the way hormones react in the body, encouraging weight loss.

The device is left inside the patient for a year, combining with lifestyle and diet changes to help reverse diabetes.

The objective is to mimic what is achieved through traditional bariatric surgery without having to undergo an extreme procedure that permanently changes the patient’s body, and is very expensive.

“We are starting to understand more about the hormones produced in the bowel, how they work and how they can control blood sugar and body weight to absorb and process nutrients from the diet,” said Dr Bu Hayee, a consultant gastroenterologist, at King’s College Hospital – UAE.

“[The procedure] has the same effect as bariatric bypass surgery. The effects are not as dramatic as what you would see through traditional operations, but the benefit is it can be done as a day case procedure and there is no need for a hospital stay or surgery.

“It involves an endoscopy via general anaesthetic that takes about half an hour to an hour to insert.

“We are trying to change the biology of the condition as the hormones that control body weight are altered by this procedure.”

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Reducing the amount of fat in someone’s liver can also alter the balance of hormones that keeps the patient in an obese, diabetic state.

Any changes made through diet and exercise encourage a temporary shift in the condition, rather than a permanent one.

“It is important to note that from a public health perspective, healthy eating and good food choices should always be encouraged first,” Dr Hayee said.

“This is not a magic bullet. By the time people are obese and have developed diabetes, diet and exercise alone will often not help in the long term.

“This [procedure] can help break the cycle and the biology of the disease.

“We know this is effective and even once the device has been removed, patients don’t revert to their original state.

“In the cases we’ve looked at, there is sometimes a gradual and slight increase in weight, but the beauty of this procedure is it can be repeated if there is a need to.”

Doctors at NMC Royal Hospital have treated an increasing number of patients in 2017 for obesity-related health conditions.

Between 2009 and 2015, the Bariatric and Metabolic Institute Abu Dhabi at Sheikh Khalifa Medical City received 940 bariatric surgery cases; however, they say operations on morbidly obese patients are increasing by more than 5,000 cases a year.

Surgery can cost up to Dh50,000, with further costly procedures likely to be necessary to remove excess skin left behind after rapid weight loss.

The solution is rarely a long-term one without drastic lifestyle adaptations, and some patients put any weight they’ve lost back on within six years.

Inserting an EndoBarrier is seen as a cost-effective alternative to bariatric surgery and should be offered to more patients as an option in the UAE, doctors have said.

According to the studies done so far on EndoBarrier, it appears to be helpful for patients with advanced type two diabetes, and particularly useful with patients with a body mass index of over 35 who find it hard to control their diabetes with medication.

Dr Dinesh Dhan Wal, a consultant endocrinologist and diabetes specialist at NMC Speciality Hospital in Dubai said obesity is one of the main risk factors of diabetes.

“If we can get patients to lose weight there is often at least a partial reversal of the condition,” he said.

“Those who have been recently diagnosed with type two diabetes and with high blood glucose levels, their beta cells are repressed.

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“With medication these cells can recover with insulin and the patient can eventually come off medication, with lifestyle and diet modifications.

“We are doing this very successfully with our patients, who must be highly motivated to lose weight and commit to a change.”

Once the patient’s beta cells start functioning again and they improve their diet and lifestyle, they can come off medication altogether in some cases.

“When patients come to me after they have had bariatric surgery, they are rarely happy. They have not always been told what they should expect,” Dr Dhan Wal said.