Background: Duodenal mucosal resurfacing (DMR) is an endoscopic intervention in which the duodenal mucosa is ablated by hydrothermal energy. DMR improves glycemic control in type 2 diabetes (T2D) through altered metabolic signaling from the duodenum causing insulin sensitization. We studied the feasibility of eliminating insulin therapy in T2D by combining DMR with GLP-1r agonism (liraglutide) and lifestyle counseling.
Methods: Single arm, single center study in 16 insulin treated T2D patients (HbA1c ≤64 mmol/mol; basal insulin <1U/kg/day, c-peptide ≥0.5 nmol/l). Day 1, DMR is administered and insulin therapy discontinued. Day 14, liraglutide is introduced (titrated to 1.8 mg/day) and life style counseling is administered throughout. Primary endpoint: percentage of patients free of insulin and HbA1c ≤59 mmol/mol at 6 months.
Results: Enrolment has been completed and 9 patients have reached 6 months with 8/9 (89%) insulin-free and able to maintain glycemic control with improvement across multiple metabolic parameters (Table 1).
Conclusion: Single endoscopic DMR, combined with liraglutide and lifestyle counseling, may effectively eliminate the need for insulin therapy in T2D while improving overall metabolic health. This treatment approach is a promising alternative that appears to shift insulin-treated T2D patients to a state of better overall metabolic health.
P. Smeele: None. A.C. van Baar: None. T.M. Vriend: None. F. Holleman: Advisory Panel; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Sanofi. M. Soeters: None. M. Nieuwdorp: Advisory Panel; Self; Caelus health. J. Tijssen: None. J.J. Bergman: Research Support; Self; Fractyl Laboratories, Inc.
