endoscopic treatment ?

[Pura Vida]

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.”

 

[LivingLightly]

Encouraging news for those type 2s who can meet the eligibility criteria.

 

[Oldvatr]

I am not happy with their explanations for this procedure. In particular the following para
"Researchers hypothesized that chronic exposure to a high-sugar, high caloric diet results in a yet unknown change to this portion of the small intestine, making the body resistant to its own insulin, Busch said. Researchers believe rejuvenating the tissue in this part of the intestine improves the body’s ability to respond to its own insulin, particularly in patients with Type 2 diabetes whose bodies still produce some insulin"

The opening statement regarding the cause of diabetes is conjecture, and not a fact. There is no evidence that that level of diet does affect the endothelial cells in the duodenum. The procedure used is electroporosis, which basically means using electricity to punch holes into body cells, causing them to leak DNA and RNA and pass in unknown amino acids from the stomach contents. The end effect is that the cells die in large numbers. It is the process used in gene splicing to harvest DNA and RNA from a sample but in vitro usually uses an inert buffer solution to prevent contamination or infection. In vivo in the stomach it depends on what the patient had recently eaten. So they seem to be killing off more cells than usual,

The stomach lining and duodenum is a highly acidic environment, so the cells die off all the time, and get replaced, so rejuvenation is a continuous process, and I fail to see why this procedure should do anything different. apart from possibly causing scar tissue.

Now the duodenum is the start of the metabolic response and it generates triggers to the alpha cells in the pancreas to release GLP-1 to cause the beta cells to output insulin. What the process seems to be doing is stop these triggers which is why the study had to use Semaglutide (Ozempic) to replace the lost GLP-1. They also had to change diet drastically to low calorie, again because of the damage to the duodenum. Both of these steps will have an immediate effect on glucose levels. I don;t see any connection to insulin resistance at all in what they have done apart from possibly the diet changes.

It seems that they have taken the success rate of the Roux-en-Y gastric bypass procedure and like the ND diet, found a cheaper way of doing it without invasive surgery. We have not been given any indication on whether this offers a long term solution or if the effects wear off as the duodenum recovers. It is probably only applicable to T2D patients who have residual pancreas output (i,e, insulin assisted rather than insulin dependant),

 

[AndBreathe]

This procedure has been around for a while, in the States and other countries, and there have been research programmes and trials in UK, since pre-pandemic.

My local Diabetes UK group had a presentation from a chap leading research in the Midlands. On the surface (pardon the pun) of it, it all looks very hopeful, but would I want something changing the surface of my innards? Not for me.

It would be a lot longer before I would be reassured that those changes did not have longer term, undesirable outcomes.

It may be I find it easy to be so sceptical having been in remission for over 9 years.

 

[Oldvatr]

This procedure has been around for a while, in the States and other countries, and there have been research programmes and trials in UK, since pre-pandemic.

My local Diabetes UK group had a presentation from a chap leading research in the Midlands. On the surface (pardon the pun) of it, it all looks very hopeful, but would I want something changing the surface of my innards? Not for me.

It would be a lot longer before I would be reassured that those changes did not have longer term, undesirable outcomes.

It may be I find it easy to be so sceptical having been in remission for over 9 years.

It is clear that this procedure is an updated version of a D&C scrape for the gut. It is literally scraping the lining off the gut. It relies on the body replacing the dead cells with vibrant new ones, but because the procedure punctures the cells to remove the DNA then hopefully the repair will be a copy of proper original specification cells from nascent stem cells, not copies of the altered ones mentioned in the hypothesis. I must presume this is how this process works, but they have not demonstrated any investigation into whether the gut cells have been altered or replaced with different ones, so it is still conjecture. The replacement of those cells happens naturally anyway.

Intestinal Mending Depends on Key Protein

Scientists identified a protein that’s essential for mending injuries to the intestinal lining in mice. The finding might have implications for understanding and repairing damage to the human intestinal wall.

www.nih.gov

Apparently we replace all the cells over a 2-4 week interval.