In a new study, researchers found that people with poorly controlled type 2 diabetes who underwent a novel, minimally invasive, endoscopic procedure called Revita duodenal mucosal resurfacing (DMR) had strongly improved blood sugar levels, liver insulin sensitivity three months later.
The research was conducted by a team at the King’s Health Partners in London, U.K.
According to the team, this outpatient procedure is being studied as the first disease-modifying therapy for type 2 diabetes and has thus far been demonstrated to be safe, effective, and durable through at least two years of follow up.
The REVITA-2 study explored the insulin-sensitizing mechanisms underlying the previously reported beneficial effects of Revita DMR therapy.
The technology involves inserting a balloon catheter through the mouth and into the duodenum (upper small intestine) to precisely deliver thermal energy to the duodenal lining.
Once treated, the damaged duodenal lining is flushed out, and a new mucosal layer begins to regenerate.
The team says the thickening of the duodenal mucosa (surface lining) occurs early in diabetes and may initiate changes in hormonal signaling that lead to insulin resistance, the main factor leading to type 2 diabetes.
By resurfacing the mucosa with the Revita DMR technique and effectively resetting this signaling, the researchers are able to demonstrate a reduction of the insulin resistance underlying diabetes and associated metabolic complications.
The researchers analyzed data from 70 patients who had a meal tolerance test before and 12 weeks after a single endoscopic procedure.
This test measures insulin secretion and insulin resistance by determining the insulin response to a “mixed meal,” which is a nutritional drink with a fixed amount of glucose and protein similar to a typical meal.
The patients’ blood glucose levels were measured before the test (while fasting) and afterward.
The team found the patients who received Revita DMR had a strongly improved glucose response, primarily driven by decreased fasting blood glucose levels, and had improved liver measures. This suggests better insulin action on the liver.
Although the average fasting glucose level dropped by only 15 milligrams per deciliter (mg/dL) in the sham group, it fell by 41 mg/dL in the DMR-treated group. Hopkins said this suggests “a primary effect on insulin resistance.
These findings confirm that the duodenum is an important therapeutic target for type 2 diabetes.
The Revita treatment has the potential to transform the lives of patients who cannot adequately control their disease with drug therapies or who are interested in a non-drug treatment alternative that targets the root cause of metabolic disease.
The lead author of the study is David Hopkins, MB.Ch.B. (M.D.), director of the Institute of Diabetes, Endocrinology and Obesity.
The study is published in the Journal of the Endocrine Society.
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