Minimally invasive procedure may free Type 2 diabetics from insulin

A small study suggests that a new procedure that treats part of the intestine just beyond the stomach may allow people with type 2 diabetes to safely stop taking insulin.

The procedure — which resurfaces the duodenum — was combined with a popular kind of diabetes medication called GLP-1 receptor agonists — such as Victoza, Trulicity, Ozempic — and counseling on lifestyle factors, such as nutrition and physical activity.

Six months after treatments began, three-quarters of participants taking insulin no longer needed it. The amount of fat stored in their livers dropped from 8% to less than 5%.

“The duodenum harbors a broad potential for the treatment of type 2 diabetes and this combination treatment could be a game-changing approach in the treatment of type 2 diabetes and the metabolic syndrome,” said lead researcher Dr. Suzanne Meiring, of Amsterdam University Medical Center in the Netherlands.

This preliminary study included 16 patients, all of whom underwent Duodenal Mucosal Resurfacing, or DMR. There was no placebo group or medication-only group for comparison. The study was funded by Fractyl Laboratories, which developed the procedure.

DMR is a minimally invasive procedure that relies on an endoscope — a narrow, flexible tube containing a light and video camera that lets your doctor see inside the body. The endoscope may also carry special tools for treatment. The tube is threaded down the throat into the digestive system.

In DMR, the endoscope is guided to the duodenum, where doctors then resurface, or ablate, its lining. Meiring said it’s not yet clear why the procedure works.

“We think the effects result from a combination of changes that occur when the duodenal mucosa is ablated and rejuvenated,” she said. “We think that changes in hormonal signaling, including the gut hormone GLP-1, bile acid compositions and the microbiome play an important role.”

The 16 participants had type 2 diabetes for an average 11 years. On average, they had been on insulin just under three years. None had taken a GLP-1 receptor agonist before the study.

At the outset, their average A1C levels — an estimate of blood sugar levels over two to three months — were under 8%. After 12 months, the average fell to 6.7%. For most adults, the American Diabetes Association recommends aiming for an A1C below 7%.

After the DMR procedure, patients were given a specific diet for two weeks. After that, they began taking the GLP-1 receptor agonist medication.

Meiring said researchers added the drug because it also targets the duodenum. They hoped it would boost the effects of DMR, “possibly even causing a synergistic effect,” she said.

She said she doesn’t think the positive effects in this study stem from just the drug treatment. Other studies have shown that about 10% of people who start GLP-1 therapy are able to get off insulin, Meiring said. In this study, 75% of those taking insulin were able to stop.

Participants who weren’t insulin-free after 12 months needed only about half the insulin they required before the procedure.

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List of Diabetes, Type 2 Medications (161 Compared)

Type 2 diabetes is the most common type of diabetes and is characterized by high levels of glucose (sugar) in the blood. Although some symptoms may be similar, it is a different condition to type 1 diabetes.

Unlike people with type 1 diabetes, most people with type 2 diabetes still produce insulin. However, it is either not enough to deal with all the glucose that is in their blood or their cells are unable to recognize the insulin and use it properly (this is called insulin resistance).

Type 2 diabetes usually affects people who are middle-aged or older, and obesity is by far the biggest risk factor. In the past two decades, the condition has become more prevalent in younger people, including children, mainly because of the rising rates of obesity in children. People who do little exercise or of certain ethnicities (such as Native Americans, African-Americans, and Hispanics) are also at higher risk of developing type 2 diabetes.

What are the Symptoms of Type 2 Diabetes?

Symptoms of type 2 Diabetes usually come on gradually and may be so subtle that many people do not realize they have the condition. Symptoms may include:

  • Always feeling thirsty
  • Feeling hungry, even though you eat regularly
  • Going to the toilet (urinating) often
  • Getting sick frequently, or frequent skin infections, particularly yeast or fungal infections
  • Infections take longer to heal
  • Feeling tired all the time or lacking in energy
  • Blurred or deteriorating vision.

How is Type 2 Diabetes Diagnosed?

Some doctors screen for diabetes in people of a certain age and it is usually always screened for in pregnant women. If you or your doctor suspects you have type 2 diabetes then they may perform a blood test on the spot that tests for blood sugar levels using a fingerprick or order a blood test that tests for blood sugar levels in the morning after an overnight fast.

Your doctor will also perform an examination and measure your blood pressure. Tests for cholesterol may also be conducted because approximately one-third of people with type 2 diabetes also have high blood pressure and high cholesterol as well.

How is Type 2 Diabetes Treated?

Even though symptoms of type 2 diabetes are barely noticeable in some people, constantly high blood sugar levels cause permanent damage to all the blood vessels and nerves in the body. Untreated diabetes can lead to an increased risk of heart attack and stroke, erectile dysfunction, foot problems, gum disease, eye and kidney disease, and many other problems.

If treatment is not started early, it is too late to reverse any damage once symptoms become more noticeable. Treatments for Type 2 diabetes include:

  • Metformin
  • Sulfonylureas
  • Meglitinides
  • Thiazolidinediones
  • DPP-4 inhibitors
  • GLP-1 receptor agonists
  • SGLT2 inhibitors
  • Insulin.

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