A novel endoscopic procedure called duodenal mucosal resurfacing (DMR) is showing promise in managing Type 2 diabetes by potentially eliminating the need for insulin injections. The early research, conducted at Amsterdam University Medical Center, suggests that a single outpatient procedure involving electrical stimulation of the duodenum can lead to lasting glycemic control.
DMR Procedure and Study Design
Led by Celine Busch and Dr. Jacques Bergman, the study involved 14 participants with Type 2 diabetes. The DMR procedure, lasting approximately one hour, delivers alternating electrical pulses to the lining of the small intestine just below the stomach. This process aims to rejuvenate the tissue and improve the body's insulin response. Patients were placed on a calorie-controlled liquid diet for two weeks post-procedure and then started on semaglutide, gradually increasing the dosage to 1 mg per week.
Significant Reduction in Insulin Dependence
While semaglutide alone can help some patients with Type 2 diabetes discontinue insulin, it typically occurs in only about 20% of cases. However, in this study, 12 out of 14 patients (approximately 86%) maintained good glycemic control without insulin for a year. This outcome suggests that the DMR procedure played a significant role in achieving these results.
Mechanism of Action
The research team theorizes that chronic exposure to a high-sugar, high-calorie diet induces changes in the lining of the small intestine, leading to insulin resistance. DMR aims to reverse this by rejuvenating the tissue in the duodenum, enhancing the body's ability to respond to its own insulin, particularly in patients who still produce some insulin.
Expert Perspectives and Future Directions
Despite the promising results, experts like Dr. Kenneth Snow have expressed cautious optimism, emphasizing the complexity of Type 2 diabetes management. Concerns have also been raised about the long-term safety and efficacy of the DMR procedure, as well as potential risks such as bleeding, infection, and damage to surrounding organs. Endogenex, the company owning the DMR technology, is funding a double-blind randomized controlled trial to further validate these findings.
Potential Impact on Diabetes Treatment
If validated in larger trials, DMR could offer a significant advancement in Type 2 diabetes treatment, potentially alleviating the burden of daily insulin injections and improving glycemic control for millions of patients. The researchers are continuing to study the long-term effects of the DMR procedure and explore new avenues to improve the lives of those living with Type 2 diabetes.
