This therapy goes beyond the mere stabilization of blood sugar levels typically achieved by diabetes drugs. Instead, it takes a step further by addressing the root cause of type-2 diabetes and actively works to reverse the body’s resistance to its own insulin, leading to a potential cure for the condition.
Although drug therapy effectively controls the disease by reducing high blood sugar levels, its effectiveness relies on continuous medication intake. In contrast, this particular procedure, according to a new study, is ‘disease-modifying’ as it addresses the root cause of Type-2 diabetes—the body’s resistance to its own insulin—and reverses it.
Over 37 million individuals in the United States are affected by diabetes, with Type 2 diabetes accounting for over 90% of cases. While Type 2 diabetes commonly manifests in individuals aged 45 and above, there is a growing trend of its occurrence among children, teenagers, and young adults.
Managing this condition often involves costly glucose-lowering medication, and the administration of insulin through injections is associated with various side effects such as the potential for low blood sugar and weight gain.
According to a preliminary first-in-human study, a procedure utilizing controlled electrical pulses to induce changes in the lining of the small intestine could offer patients with Type 2 diabetes the opportunity to discontinue insulin usage while still maintaining glycemic control.
These findings will be presented at Digestive Disease Week® (DDW) 2023.
The study, led by Celine Busch, a PhD candidate in gastroenterology at Amsterdam University Medical Center, highlights the potential benefits of this outpatient endoscopic treatment as an alternative to drug therapy that requires daily medication intake.
“The potential for controlling diabetes with a single endoscopic treatment is spectacular,” remarks lead researcher Celine Busch.
According to the author, one of the main benefits of this therapy is that glycemic control may be achieved with only one outpatient endoscopic operation, which is an improvement over pharmacological treatment that requires patients to take their medicine regularly.
The study involved 14 patients who underwent an hour-long endoscopic procedure where alternating electrical pulses were delivered to the duodenum, the section of the small intestine just below the stomach. Following the procedure, patients were discharged on the same day and placed on a calorie-controlled liquid diet for two weeks. Subsequently, they began taking semaglutide, a diabetes medicine, gradually increasing the dosage to 1 mg per week.
Although semaglutide alone enables some Type 2 diabetes patients to discontinue insulin usage in about 20% of cases, this study revealed that 12 out of 14 patients (86%) achieved and maintained good glycemic control without insulin for a year. This suggests that the positive outcome is likely associated with the procedure itself rather than solely relying on semaglutide. The authors of the study are planning a double-blind randomized controlled trial to further validate these results.
Principal investigator Jacques Bergman, M.D., PhD, a professor of gastrointestinal endoscopy at Amsterdam University Medical Center, explained the difference between the procedure and drug therapy, stating, “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 research on gastric bypass surgery, which exhibited improved insulin control immediately after the procedure, led researchers to investigate modifying the lining of the small intestine using heat-based ablation. This observation indicated that bypassing a particular section of the small intestine plays a role in glycemic control for Type 2 diabetes, even before any weight loss occurs.
Researchers involved in the current study hypothesized that chronic exposure to a high-sugar, high-caloric diet results in an unknown change in this specific portion of the small intestine, leading to the body’s resistance to its own insulin. By rejuvenating the tissue in this region, researchers believe the body’s response to its own insulin improves, particularly among patients with Type 2 diabetes who still produce some insulin.
The study received full funding from Endogenex, a Minnesota-based company that owns the technology employed in the endoscopic procedure. Dr. Bergman also serves on the advisory board of Endogenex.
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