New procedure encourages cell growth and spurs the pancreas to produce insulin once again in some people.
A new treatment that encourages cell growth may have the potential to put diabetes into remission in some patients.
Researchers have outlined the new procedure in a study recently published in Diabetes Care.
The researchers have been looking at a process that involves regrowing the cells on the surface of a patient’s small intestine.
These new cells then spur the pancreas to produce adequate amounts of insulin again.
This could allow many with type 2 diabetes who are taking oral medications to avoid insulin injections as well as put their disease into remission.
This promising new treatment — known as “duodenal mucosal resurfacing” — involves inserting a thin tube with a small balloon attached to one end through a sedated patient’s mouth and into the stomach.
The tube is then positioned at the top of the small intestines, at which point the balloon is filled with hot water.
The heat from that hot water destroys the endothelial cells on the surface of the small intestines — a technique called ablation therapy.
This then encourages the growth of new healthy cells and improves the patient’s ability to produce insulin.
While it’s early in the ongoing observation of the results, this method has been effective for more than one year after study participants first received treatment.
That’s because the lining of the small intestines is largely responsible for the production of insulin.
After food is digested in the stomach, it travels to the small intestine, where glucose produced from that food is absorbed into the bloodstream.
This process signals the pancreas to produce insulin. That insulin helps transport the glucose into every area of the body that relies on it.
Without enough insulin, glucose builds up in the bloodstream.
That’s what leads to dangerously high blood sugar levels that damage the nerve endings and blood vessels throughout the body, including those in the eyes, fingers, and toes.
The results of this new procedure were similar to that of patients who have received gastric bypass surgery.
Researchers said there was improvement in blood sugar levels for study participants within a few days and weeks.
This improvement happened regardless of diet or weight loss.
“Contrary to common perception of type 2 diabetes, they’ve found that low insulin production is a major factor for most people with type 2 diabetes, not insulin resistance,” explained Gretchen Becker, medical journalist and author of “The First Year: Type 2 Diabetes.”
Becker told Healthline that most patients with type 2 diabetes have varying degrees of insulin resistance, but so do people who don’t have diabetes.
While the bodies of those in the latter category simply produce more insulin to compensate, a person with type 2 diabetes doesn’t seem to be able to.
“Most genes related to type 2 diabetes concern insulin production, not insulin resistance,” Becker said.
She added this contributes to why the ablation of the small intestines’ lining has proven to be so effective in normalizing patients’ ability to maintain healthy blood sugar levels.
“Quite a few years ago, in Chile, a similar procedure was being studied that involved inserting a balloon into the small intestines to act as a lining, so the food never touched the wall during digestion,” explained Grunberger.
“Consequently, the patients’ blood sugar levels regulated themselves, simply by interrupting and preventing that interaction with the mucosal lining.”
Ever since, Grunberger said everyone has been trying to convince the Food and Drug Administration (FDA) about the safety of this type of procedure.
“If you catch people early in the game of diabetes,” explained Grunberger, “you can put diabetes into remission by renewing or blocking the interaction with the lining of the small intestines, but for how long? We don’t know yet.”
In his own practice, Grunberger sees an 80 to 95 percent success rate in achieving diabetic remission through traditional gastric bypass or gastric sleeve procedures.
Both of these procedures involve removing or limiting contact with a certain portion of the small intestines.
“These types of procedures have proven to improve glucose tolerance virtually immediately,” he explained. “This means it isn’t the result of calorie restriction or weight loss, but in merely interrupting that normal interaction with the mucosal lining.”
That being said, those who maintain remission in the long term are still those who are able to successfully lose weight and sustain it.
“I have patients who have undergone gastric bypass who were on insulin for years prior to surgery,” explained Grunberger. “They don’t need insulin anymore, they maintain an HbA1c of 5.2 percent, and they come back every year just to say, ‘Hi.’”
Grunberger also has patients who don’t change their habits and regain most of the weight. But even then, many of them are able to use other diabetes medications instead of going back to insulin injections.
The real hurdle this study — and those like it — will have to overcome is demonstrating not only its safety but also its long-term efficacy.
If a patient’s success after duodenal mucosal resurfacing only lasts for a few years, it’s unlikely insurance companies would be willing to pay for it.