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Researchers say an endoscopic procedure may help people with type 2 diabetes who need insulin. Pascal Deloche/Godong/Universal Images Group via Getty Images
  • Researchers say a new endoscopic procedure may be able to reduce the need for insulin for some people with type 2 diabetes.
  • They say the one-hour procedure works by making changes in the lining of the small intestine.
  • Experts say the procedure looks promising, but they add that the best prevention against type 2 diabetes is to maintain a healthy weight.

An endoscopic procedure that makes changes to the lining of the small intestine could reduce the need for insulin for some people with type 2 diabetes, according to a study presented at Digestive Disease Week 2023.

In their study, researchers used a one-hour endoscopic procedure that delivered electrical pulses to the duodenum, a portion of the small intestine lining located right below the stomach.

This is an early-stage study that hasn’t been published yet in a peer-reviewed journal. The research was funded by Endogenex, the company that owns the technology used in the procedure.

“If this therapy is proven effective, it could eliminate the need for medication or insulin, or potentially prevent disease progression so it does not lead to organ failure and other debilitating conditions,” Dr. Luke Putman, a lead investigator of the study and a gastrointestinal surgeon at Keck Medicine of USC in California, said in a press release.

In the study, 14 participants underwent the hour-long outpatient procedure.

They then followed a calorie-controlled liquid diet for the next two weeks. Afterward, they were started on the weight-loss drug semaglutide, which was titrated up to a dose of 1 mg per week.

The U.S. Food and Drug Administration approved Wegovy (a semaglutide) in 2021 for chronic weight management in people who are overweight or have obesity and at least one additional condition, such as high blood pressure or type 2 diabetes.

The researchers noted that people taking semaglutide can sometimes stop taking insulin, but this usually occurs in only about 20% of patients.

In the current study, the researchers reported that 86% (12 out of the 14 participants) maintained glycemic control during the one-year follow-up.

They said this suggests the endoscopic procedure, not just the semaglutide, provided continued improvement.

The scientists hypothesize that chronic exposure to a high-sugar, high-caloric diet could result in a still unknown change to the lining of the duodenum, causing the body to be resistant to its insulin.

They said rejuvenating the tissue might improve the body’s ability to respond to insulin, especially in people with type 2 diabetes who still produce some insulin.

Dr. Rudolph Bedford, a gastroenterologist at Providence Saint John’s Health Center in California who was not involved in the study, agrees with the hypothesis.

“In my experience, I have seen that high-sugar, high-calorie diets damage the cells in the small intestine,” he told Medical News Today. “This procedure might work because it damages the lining of the duodenum and new, healthy cells grow in their place. The hope is that these cells can better respond to insulin. Of course, changes in the diet to reduce sugar intake are important to keep the cells healthy.”

The scientists plan to work on a double-blind, randomized control study next.

“Before we can take action on this information, we need more clinical data,” Bedford said. “Although I was aware of the study and have heard the hypothesis before, we need more information. It is still early in this process, and it could be years before we know one way or another whether this procedure will work. But overall, it is very exciting and holds great promise.”

Dr. Mir Ali, a bariatric surgeon and medical director at MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in California who also was not involved in the study, agrees that additional research is needed.

“Definitely, we need to see results on more people; 14 patients does not provide us with a good background,” Ali told Medical News Today.

“The surgery might be a good step,” Ali said. “However, if we aren’t treating the underlying cause, it isn’t going to help. For example, if someone has diabetes and is overweight, we should treat the excess weight. Otherwise, the treatment doesn’t help much because the weight remains and can continue to cause insulin resistance.”

“Focusing on maintaining a healthy weight is most important,” he added. “This can greatly reduce the risk of diabetes and other weight-related illnesses.”

Experts say you can reduce your risk of developing type 2 diabetes by changing lifestyle habits. Losing even a small amount of weight and getting more physically active can help, according to the Centers for Disease Control and Prevention.

Anne Danahy, a registered dietitian and nutritionist specializing in disease prevention and management, provided Medical News Today with some tips for reducing your risk of developing diabetes:

  • Always start with your diet. Carbohydrates impact glycemic control most, but not all carbs are created equal.
  • Try to get most (or all) of your carbs from whole fruits, vegetables, whole grains (like oats, shredded wheat, quinoa, millet, and farro), and legumes. These low-glycemic foods won’t spike your blood sugar and force your insulin to work overtime. They take longer to digest, so they’ll keep you feeling full for longer. And as you digest them, the glucose they provide gets into your bloodstream slowly, providing a long-lasting source of energy.
  • Limit foods with added sugar as much as possible. An occasional dessert is OK, but most days, try to satisfy your sweet tooth with a bowl of fresh berries or a slice of fresh melon instead. Or slice up a banana, dip the slices in unsweetened dark chocolate, sprinkle with chopped nuts, and keep those in the freezer for a healthier sweet treat.
  • I advise people to avoid soft drinks with added sugar, like sodas and sweetened tea. Coffee, energy, and commercially prepared smoothies typically have added sugar. These can all send your insulin into overdrive. It’s also important to note that drinking sweetened beverages promotes weight gain, specifically belly (visceral) fat which worsens insulin resistance.
  • Other helpful strategies include eating smaller meals (add a snack or two in between meals if necessary) earlier in the day. Finish eating dinner by 6 or 7 pm and allow your body to fast for at least 12 to 14 hours. And try to move more throughout the day, especially after a meal. One study showed you can reduce blood sugar by taking a light 15-minute walk after a meal. Even taking standing breaks every 30 minutes instead of sitting all day helps improve blood sugar.