One-Hour Endoscopic Procedure Could Eliminate Need for Insulin for Type 2 Diabetes

Over 37 million Americans are diagnosed with diabetes, and more than 90% of these cases are Type 2 diabetes. This form of diabetes is most commonly seen in individuals over 45, though an increasing number of children, teenagers, and young adults are being diagnosed. Managing glucose can be costly with medications, and using insulin injections comes with side effects such as the risk of low blood sugar and weight gain. Now, an innovative procedure that involves the use of controlled electrical pulses to alter the lining of the first part of the small intestine could enable patients with Type 2 diabetes to discontinue insulin use while maintaining control of their blood glucose levels.

Previous research had studied the effects of ablating the small intestine's lining with heat, particularly after noting that patients undergoing gastric bypass surgery showed immediate improvements in insulin regulation post-operation, prior to any weight loss. This observation led researchers to propose that bypassing a specific part of the small intestine contributes to blood sugar management in Type 2 diabetes. It is theorized that prolonged exposure to a diet high in sugar and calories triggers an unidentified change in this intestinal segment, which in turn causes resistance to the body's insulin. Rejuvenating this intestinal tissue may enhance the body's responsiveness to its insulin, especially in Type 2 diabetes patients who still produce insulin naturally.

In a pioneering study conducted at the Amsterdam University Medical Center (Amsterdam, the Netherlands), 14 patients were treated with an endoscopic procedure that applied alternating electrical pulses to the duodenum—the section of the small intestine just below the stomach. This procedure lasted about an hour, after which patients were released the same day. They then followed a calorie-controlled liquid diet for two weeks. Subsequently, these patients started on semaglutide, a diabetes medication, gradually increasing the dose to 1 mg per week. While semaglutide alone typically enables roughly 20% of Type 2 diabetes patients to stop using insulin, in this study, 12 out of 14 patients, or 86%, successfully maintained optimal glycemic control without insulin for an entire year. This suggests that the improvements could be attributed to the new procedure rather than solely to the medication. Researchers are now initiating a double-blind randomized controlled trial to further investigate these findings.

“The potential for controlling diabetes with a single endoscopic treatment is spectacular,” said Celine Busch, the study’s lead researcher and PhD candidate in gastroenterology at Amsterdam University Medical Center. “One of the biggest advantages of this treatment is that a single outpatient endoscopic procedure provides glycemic control, a potential improvement over drug treatment, which depends on patients taking their medication day in, day out.”

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