A procedure that involves inflating a hot balloon in the intestines could reverse type 2 diabetes and free thousands of patients from daily insulin injections, doctors say.
The groundbreaking surgery will be offered to a handful of UK patients as part of an international trial, after promising initial results showing that three-quarters of those who underwent it dumped the drug.
The technique, known as duodenal mucosal resurfacing, involves threading the balloon onto a long, thin tube through the throat, stomach, and then the duodenum, the first part of the small intestine.
The groundbreaking surgery will be offered to a handful of UK patients as part of an international trial, after promising initial results showing that three-quarters of those who underwent it dumped the drug
The treatment is effective in three quarters of the patients treated, allowing them to control their blood sugar levels without the use of drugs
Cells lining the duodenum are key to controlling blood sugar. They detect when sugars are being consumed and prepare the body to produce hormones, including insulin, that help cells absorb it.
But in type 2 diabetics, the walls of the duodenum become thickened due to poor nutrition. It no longer signals the release of insulin, which means that sugar is not absorbed and builds up in the blood, causing widespread damage over time.
Medication keeps blood sugar in check. Some take tablets that help the body excrete sugar, but one in five has more serious problems and injections of insulin.
Duodenal mucosal resurfacing surgery is for these people.
The heated balloon burns away the thickened, non-functioning cells in the duodenum, allowing new healthy cells to grow – experts describe the effects as ‘rejuvenating’ the intestinal wall. This doesn’t cure diabetes, but it does mean that the body makes more insulin, which lowers blood sugar.
One of the first patients to benefit from this is Cor Tuinenburg, a 57-year-old electrical engineer from a city near Amsterdam. He took part in an early study of the duodenal mucosa in 2018, after living with type 2 diabetes for 20 years.
“I started on insulin in 2012 because my other medications were no longer controlling my blood sugar levels, but it made me gain weight,” he said. Desperate for a solution, Cor’s wife read about the re-emergence trial of the duodenal mucosa and managed to enroll Cor. He underwent the procedure in December 2018. ‘Since then I have been able to get rid of insulin and now have healthy blood sugar. I feel like new. ‘
Diabetes expert Dr Alex Miras of Imperial College Healthcare NHS Trust, London, said: “If I get the chance, I think most patients would want to stop taking insulin. Not only are daily injections required, but weight gain is a common side effect, and there is also the risk of blood sugar falling too low, causing ‘hypos’. [hypoglycaemia – a dangerous condition which, without treatment can ultimately lead to loss of consciousness or be fatal]. ‘
The procedure takes about an hour and is performed by a gastrointestinal specialist.
While the patient is being sedated, a fine flexible tube and camera are inserted through the mouth and stomach into the duodenum. Water heated to 90 ° C is then pumped through the tube to inflate the balloon – about the size of a cocktail sausage. This is displaced through the 10in channel, burning the damaged cells.
“Duodenal scans taken a few days after surgery show that the thickened lining has disappeared, and after three months the regrowth of healthy cells can be seen,” says Dr. Miras.
The effects last for up to two years after the procedure – and patients are expected to lose up to a stone on average from stopping insulin.
Fractyl, the company that makes duodenal mucosal resurfacing technology, is currently recruiting patients for the upcoming study.
There are plans to treat up to 430 type 2 patients aged 21 to 70 in studies conducted at 35 sites in the UK, Europe and the US.
Previous UK trials of duodenal mucosa re-emergence, also known as the Revita procedure, were conducted at Kings College and University College Hospital in London.
“I would recommend it to everyone,” said Mr. Tuinenburg. ‘I’ve had a dog since the surgery and I walk her every day. I have built a veranda on our new house, laid out a garden and am actively involved with our four grandchildren.
“Three years ago, I doubted I would ever come back to this.”
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