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controlling diabetes with endoscopic treatment: research

preliminary study offers people living with diabetes hope that they may be able to have good glycemic control without medication.

by dave yasvinski

may 3 2023
read time 3 minute read
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2.3 million canadians lived with diabetes in 2017
diabetes increases the risk of heart disease, stroke and kidney disease. getty
a single outpatient procedure may soon make it possible for people with type 2 diabetes to maintain glycemic control without the use of expensive medication.
the preliminary study, which was fully funded by endogenex — the company behind the technology — will be presented at this year’s digestive disease week. the procedure works by using electrical pulses to induce changes to the lining of the duodenum, the first part of the small intestine.
“the potential for controlling diabetes with a single endoscopic treatment is spectacular,” said celine busch, the study’s lead researcher and a 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.”

type 2 diabetes accounts for 90 to 95 per cent of total diabetes diagnoses

roughly 2.3 million canadians reported a diabetes diagnosis as of 2017, according to statistics canada, with type 2 diabetes accounting for 90 to 95 per cent of cases. the metabolic disease occurs when the body does not produce enough insulin or is unable to properly process the insulin it does produce. in addition to increasing the risk of conditions such as heart disease, stroke and kidney disease, diabetes can also reduce quality of life through the burden of the daily management of symptoms.

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researchers have recently focused on the lining of the small intestine as a key player in the progression of type 2 diabetes after realizing that patients who underwent gastric bypass surgery experienced enhanced insulin control immediately after surgery but before any weight loss had occurred. this led to the suspicion that chronic exposure to a high-sugar, high caloric diet can cause unknown changes in this area that makes the body resistant to its own insulin.
the team behind the current study sought to address this inability by rejuvenating the tissues lining in this area. to do this, they recruited 14 patients into an early-stage study and performed an hour-long endoscopic procedure that involved sending alternating electrical pulses to the lining of the small intestine that lies just below the stomach.
patients were discharged the same day as the procedure and put on a calorie-controlled liquid diet for two weeks. they were also prescribed a diabetes medication known as semaglutide that has been found, on its own, to allow around 20 per cent of people with type 2 diabetes to quit taking insulin. however, in this study, 12 of 14 patients, or 86 per cent of participants, were able to maintain good glycemic control without insulin for a year. this suggests that any additional improvements were related to the new treatment and not the medication. the team has just begun a double-blind, randomized trial to test and expand upon their findings.
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“while drug therapy is ‘disease-controlling,’ it only reduces high blood sugar as long as the patient continues taking the medication,” said jacques bergman, principal investigator of the study, professor of gastrointestinal endoscopy at amsterdam university medical center and advisory board member for endogenex. “this one procedure is ‘disease-modifying’ in that it reverses the body’s resistance to its own insulin, the root cause of type 2 diabetes.”

dave yasvinski is a writer with  healthing.ca

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