Endoscopic procedure offers hope to insulin dependent type 2 diabetics
Type 2 diabetics could soon be able to control their own blood sugar levels without the need to take insulin.
Researchers say a new hour-long procedure that uses controlled electrical pulses to induce changes in the lining of the first part of the small intestine, has shown promise in helping type 2 diabetics maintain glycemic control, doing away with the need to take frequent doses of insulin.
The news offers hope to the 462 million individuals globally affected by type 2 diabetes, around 30% of whom are insulin dependent.
The findings of the preliminary first-in-human study are due to be presented on May 9 at this year’s Digestive Disease Week in Chicago.
Celine Busch, the study’s lead researcher and PhD candidate in gastroenterology at Amsterdam University Medical Center, has described the potential for controlling the disease with a single endoscopic treatment as “spectacular.”
She said: “One of the biggest advantages of this treatment is that a single outpatient endoscopic procedure provides glycemic control, a potential improvement over drug treatment, which depends on patients taking their medication day in, day out.”
Type 2 diabetes most often develops in people between the ages of 45-64, but an increasing number of children, teenagers and young adults are being diagnosed with it. More than 600 million people are expected to be living with the condition globally by 2040.
A progressive chronic disease, the primary problem is the inability of the body’s cells to use insulin properly and efficiently, leading to hyperglycemia (high blood sugar) and diabetes. About 90% of diabetics have type 2.
Most type 2 diabetes patients need some form of medicine – usually in the form of a tablet – to keep their blood sugar levels are normal as possible to prevent further health problems. But the longer a person takes this kind of medication the more chance there is that it will stop working. It is then that patients will need to begin using insulin.
Injecting insulin has several side effects, however, including the risk of low blood sugar and weight gain.
In this early-stage study, 14 patients underwent an endoscopic procedure in which alternating electrical pulses were delivered to the duodenum, a portion of the lining of the small intestine just below the stomach.
After the hour-long procedure, patients were discharged on the same day and then put on a calorie-controlled liquid diet for two weeks. Patients then began taking semaglutide, a diabetes medicine, titrating up to 1 mg a week.
Semaglutide on its own sometimes allows patients with type 2 diabetes to stop taking insulin, but only in about 20% of cases, Ms Busch said.
In this study, 12 of 14 patients, or 86%, maintained good glycemic control without insulin for a year, suggesting the improvement is related to the procedure and not just to the semaglutide.
The study’s authors are now starting work on a double-blind randomized controlled trial to test these results.
Jacques Bergman, the study’s principal investigator and professor of gastrointestinal endoscopy at Amsterdam University Medical Center, who also serves on the advisory board of Endogenex, the US-based company that funded the research and owns the technology used for the endoscopic procedure, said: “While drug therapy is ‘disease-controlling,’ it only reduces high blood sugar as long as the patient continues taking the medication. This one procedure is ‘disease-modifying’ in that it reverses the body’s resistance to its own insulin, the root cause of the type-2 diabetes.”
Previous researchers have explored the impact of ablation – using heat to modify the lining of the small intestine- after noticing that patients who underwent gastric bypass experienced improved insulin control immediately after the surgery, even before any weight loss. This indicated that going round this portion of the small intestine plays a role in the glycemic control in type 2 diabetes.
The study team hypothesised that chronic exposure to a high-sugar, high caloric diet results in a yet unknown change to this portion of the small intestine, making the body resistant to its own insulin, Ms Busch explained.
Researchers believe rejuvenating the tissue in this part of the intestine improves the body’s ability to respond to its own insulin, particularly in patients with type 2 diabetes who still produce some of their own.
