An experimental minimally invasive procedure that resurfaces the first 8 or 9 inches (23 cm) of the small intestine is allowing some patients with type 2 diabetes to stop taking insulin, according to findings from a small study.
The treatment destroys cells in the mucosa, or lining, of the duodenum. When the mucosa regenerates with healthy new cells, the body's response to its own insulin from the pancreas improves, researchers found.
At Amsterdam University Medical Center, 14 patients underwent an hour-long endoscopic procedure during which alternating electrical pulses were delivered to the duodenum using equipment manufactured by study sponsor Endogenex Inc.
Patients went home the same day and followed a calorie-controlled liquid diet for two weeks, after which they began taking Novo Nordisk's once-weekly Ozempic (semaglutide).
One year later, 86% were still maintaining good blood-sugar control with weekly semaglutide and without insulin, senior researcher Dr. Jacques Bergman said at a news conference. His team will present the data at the Digestive Disease Week conference in Chicago next week.
Another company - Fractyl Health - is already testing its duodenal ablation equipment in later-stage trials. Its Revita DMR System is commercially available in Germany.
Bergman said Fractyl's technology uses heat and results in patchy, uneven resurfacing of the mucosa, whereas the Endogenex procedure is non-thermal and achieves a more homogenous effect. He expects a randomized control trial with the Endogenex tools to begin soon.
Duodenal ablation "improves patients' sensitivity to their own insulin," Bergman said.
Insulin resistance is the root cause of type 2 diabetes, he noted. As type 2 diabetes becomes more advanced and the pancreas produces less and less insulin, the procedure is less likely to work, he added.
Dr. Loren Laine of the Yale School of Medicine, who moderated the news conference, said controlling diabetes with a single endoscopic treatment "is going to be incredible, if it does pan out in clinical trials."
