Duodenal mucosal resurfacing plus liraglutide eliminates need for insulin in type 2 diabetes
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Adding liraglutide and lifestyle counseling to duodenal mucosal resurfacing eliminated the need for insulin therapy in most patients with type 2 diabetes through 18 months, according to data from a feasibility study.
“[In] this feasibility study, [duodenal mucosal resurfacing (DMR)], combined with [liraglutide] and supported by lifestyle counselling, eliminated the need for insulin therapy in the majority of [type 2 diabetes] patients after 6, 12 and 18 months, while improving their glycemic and metabolic health,” Annieke C.G. van Baar, MD, PhD candidate, from the department of gastroenterology and hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands, and colleagues wrote. “Given the limited size and uncontrolled nature of this study, randomized sham-controlled studies are required to confirm its findings.”
Van Baar and colleagues’ study comprised 16 patients with insulin-treated type 2 diabetes who underwent a single duodenal mucosal resurfacing (DMR). After DMR, researchers assigned patients a 2-week postprocedural diet then they introduced the glucagon-like peptide-1 receptor agonist (GLP-1RA) liraglutide. The percentage of patients without insulin with an HbA1c less than 7.5% at 6 months served as the primary endpoint. Secondary endpoints included changes in multiple glycemic and metabolic parameters and percentage of responders at 12 and 18 months, respectively.
Results showed all patients underwent successful duodenal mucosal resurfacing with no procedure-related serious adverse events. Sixty-nine percent of patients were off insulin therapy and had an HbA1c of 7.5% or less at 6 months. At 12 months, 56% of patients remained off insulin, and 53% at 18 months.
According to the researchers, there were significant improvements in all patients in Homeostatic Model Assessment for Insulin Resistance, BMI, weight and liver fat fraction.
“[It] would also be interesting to observe what happens after 18 months, and to investigate whether retreatment with DMR is effective,” the investigators wrote.
Perspective
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Alberto Rubio Tapia, MD
Duodenal mucosal resurfacing is an emerging outpatient endoscopic procedure that targets distal duodenal pathology for several centimeters as a therapeutic option for metabolic diseases such as obesity, fatty liver, and type 2 diabetes. This study shows promising early results of a combination strategy including duodenal mucosal resurfacing and liraglutide (a medication approved for treatment of type 2 diabetes) to improve control of type 2 diabetes in patients requiring insulin. These data provide insight into a potential therapeutic opportunity for patient with type 2 diabetes. A recent double-blind, prospective, sham-controlled, multicenter study confirmed safety of duodenal mucosal resurfacing procedure and efficacy to improve hemoglobin A1c in European patients with poorly controlled type 2 diabetes. The potential need to repeat the endoscopic procedure to maintain benefits, long-term efficacy, and heterogeneity of response among different populations will require further study.
Reference:
Mingrone G, et al. Gut. 2021; doi:10.1136/gutjnl-2020-323608.
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