Endoscopic DMR may eliminate need for insulin to control blood sugar in diabetes

Netherlands: Duodenal mucosal resurfacing (DMR) combined with liraglutide and lifestyle counseling may effectively do away with the need for insulin therapy in type 2 diabetes (T2D) for adequate blood sugar control, a recent study in the ADA journal Diabetes has found. The results of the study were also presented at the American Diabetes Association' (ADA) Virtual 80th Scientific Sessions.

Despite a wide choice of pharmacological medications, many patients do not achieve adequate control of high blood sugar . Furthermore, most of the available pharmaceutical approaches do not adequately address the underlying pathophysiological defects, particularly insulin resistance.

Duodenal mucosal resurfacing (DMR) is a novel endoscopic procedure that has been shown to improve blood sugar control in people with type 2 diabetes mellitus (T2D) irrespective of body mass index (BMI) changes.

DMR is an endoscopic intervention that involves the ablation of duodenal mucosa by hydrothermal energy. It is known to improve blood sugar control in T2D through alteration of metabolic signaling from duodenum causing insulin sensitization. Paul Smeele from Amsterdam, Netherlands, and colleagues studies the feasibility of insulin therapy elimination in TD by combining DMR with lifestyle counseling and GLP-1r agonism (liraglutide).

The single-arm, single-center study was conducted in 16 insulin-treated T2D patients (HbA1c ≤64 mmol/mol; basal insulin <1U/kg/day, c-peptide ≥0.5 nmol/l). They had HbA1c ≤64 mmol/mol; basal insulin <1U/kg/day, c-peptide ≥0.5 nmol/l. On day 1, DMR was administered and insulin therapy discontinued. On day 14, liraglutide was administered throughout. The primary endpoint was the percentage of patients free of insulin and HbA1c ≤59 mmol/mol at 6 months.

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9 patients reached 6 months with 8/9 (89%) insulin-free and also they were able to maintain blood sugar control with improvement across multiple metabolic parameters.

"Single endoscopic DMR, combined with liraglutide and lifestyle counseling, may effectively eliminate the need for insulin therapy in T2D while improving overall metabolic health. This treatment approach is a promising alternative that appears to shift insulin-treated T2D patients to a state of better overall metabolic health.

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The study, "Duodenal Mucosal Resurfacing (DMR) Combined with GLP-1 RA May Eliminate Insulin Therapy and Improve Metabolic Health in Type 2 Diabetes," is published in the ADA journal Diabetes.

DOI: https://doi.org/10.2337/db19-1156-P