By George Citroner
As of 2019, the latest year for which data are available, more than 37 million people in the United States—or 11.3 percent of the country’s population—are living with diabetes, according to the U.S. Centers for Disease Control and Prevention. Among them, 8.5 million are adults who are undiagnosed or unaware that they have the condition. For those who require insulin, easy access is essential. However, problems such as shortages and unpredictable pricing can create significant obstacles.
A preliminary first-in-human study, to be presented at Digestive Disease Week 2023 on May 6–9, has found that a minimally invasive procedure may potentially eliminate the need for prescription insulin for a year in patients with type 2 diabetes.
Freeing Type 2 Diabetics From Insulin Dependence
Globally, 79 million people with type 2 diabetes will need insulin by 2030, and half won’t have access to the drug, according to research published in 2018 in The Lancet’s Diabetes & Endocrinology journal.
The new study tested a procedure, which uses controlled electrical pulses to make changes to the lining of the first part of the small intestine, called the duodenum, and found that it may help patients with type 2 diabetes maintain control of their blood sugar levels for at least a year without requiring insulin, according to the researchers. This could improve patients’ long-term health outcomes because taking insulin may contribute to weight gain and other problems associated with being overweight.
The procedure, known as duodenal mucosal ablation and regeneration (DMR), has been demonstrated to enhance glycemic control in individuals with type 2 diabetes, regardless of their body mass index (BMI).
The procedure removes the lining of the duodenum, which plays an essential role in digestion and nutrient absorption, and allows it to regenerate new, healthy tissue.
Earlier research on 46 patients who underwent DMR showed it to be a “feasible and safe endoscopic procedure” that stimulated long-lasting glycemic improvement in poorly controlled type 2 diabetes patients who used oral glucose-lowering medication, whether or not they lost weight.
DMR Plus Semaglutide (Sold Under Brand Name Ozempic)
For this early-stage study, 14 patients underwent a fork of DMR called re-cellularization via electroporation therapy (ReCET), an endoscopic procedure that uses electroporation—a process in which an electric field is applied to cells or tissues to create temporary pores in their cell membranes—triggering cell death and eventually leading to regeneration of healthy tissue.
After the hour-long procedure, patients were discharged that same day and put on a calorie-controlled liquid diet for two weeks. After that, they started taking semaglutide, a diabetes medication sold commercially under the name Ozempic and taken by celebrities for weight loss. The dosage was gradually increased to 1 milligram per week.
Out of the 14 patients, 12 could maintain good glycemic control without using insulin for a year, indicating that their improvement was likely due to the DMR procedure rather than solely semaglutide. The researchers say they plan to conduct a double-blind, randomized, controlled trial to test these findings further.
Lead researcher of the study Celine Busch, a doctoral candidate in gastroenterology at Amsterdam University Medical Center, said that while semaglutide alone may allow some patients with type 2 diabetes to stop taking insulin, this is only the case in about 20 percent of cases.
“In our study, the combination of ReCET and semaglutide had a success rate of 86 percent,” Busch told The Epoch Times. “We hypothesize that ReCET and semaglutide act in synergy, boosting each other’s effect on improving glycemic control.”
ReCET Improved Insulin Sensitivity
The procedure improves the body’s sensitivity to its own insulin, but how it does that isn’t yet fully understood, according to Busch. “We think that the ReCET procedure enhances the sensitivity of the body to endogenous insulin,” she said. “[But] by combining ReCET with the GLP-1 receptor agonist semaglutide, which stimulates endogenous insulin production, a synergistic effect on glycemic control is achieved.”
However, the procedure won’t work for type 1 diabetics.
In people with type 2 diabetes, the body has developed a resistance or reduced sensitivity to insulin. The ReCET procedure, in combination with semaglutide, helps to increase the body’s sensitivity to its own insulin. However, people with type 1 diabetes cannot produce insulin at all. “So there is no room for enhancing the body’s insulin sensitivity nor for enhancing the production of insulin,” Busch said.
Insufficient Supply as Demand Grows
Even as this recent study shows ReCET can help relieve type 2 diabetes patients’ reliance on insulin, the popularity of its companion therapy, semaglutide, as a weight loss drug is creating shortages for those who need it to treat diabetes.
Telehealth and social media are playing a significant role in driving demand for the drug.
Semaglutide, now sold under the brand name Wegovy and used namely for chronic weight management, is experiencing production problems due to the high demand. In 2022, shortages became critical. Novo Nordisk, the manufacturer of Wegovy, announced that it had been “continuously monitoring prescribing trends to assess overall U.S. demand.” The company warned that “demand for Wegovy in the U.S. will exceed our current supply capacity.”