Using an endoscopic procedure to reach the duodenum

Killing cells from inside the duodenum of the small intestine could help control blood sugar levels among those with type 2 diabetes, researchers have said.

A US team say previous studies have shown that carrying out a procedure known as a DMR could help to lower HbA1c levels and manage type 2 diabetes.

DMR stands for Duodenal Mucosal Resurfacing, and involves using a catheter to deliver a balloon filled with extremely hot water (around 80 degrees Celsius) to the duodenum.

The duodenum is located between the stomach and the middle part of the small intestine. It is thought this part of the stomach becomes enlarged and stops working properly when it is exposed to an unhealthy diet for a number of years.

The hot water is then directed to burn cells lining the duodenum, which are thought to grow back healthily.

To test whether this approach could make a significant difference to people with diabetes, five institutions in America are trialling the procedure.

Results are not yet available, but Professor Gregory Ginsberg, Professor of Medicine at the Hospital of the University of Pennsylvania said the previous research has made him hopeful that he is studying a “transformative” procedure.

He added, “This research is compelling because it harnesses the untapped potential of the luminal digestive tract in the management of health and disease. Moreover, it is provocative in its application of minimally invasive endoscopic therapy to treat a metabolic condition.”

This rejuvenating process resets hormone production within the intestine part of the organ, the lion’s share of which are linked to metabolism and related diseases.

DMR was largely inspired by gastric bypass surgeries that have had promising results for type 2 diabetes. Bypass surgery results in partially digested food bypassing the duodenum. Obese patients with type 2 diabetes who undergo bypass surgery have been reported to see improvement in diabetes markers even before weight loss occurs. This sparked interest in the role the duodenum plays in metabolism, and led to these DMR trials.

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