No More Insulin Shots?

Could the future hold an attractive alternative to insulin shots for type 2 diabetics?

Sesha Subramanian
19th November 2018

Scientists in Amsterdam have trialled a new treatment model for Type 2 diabetes which, if it finds its way into mainstream medicine, could prove to be revolutionary in the treatment of a problem that affects millions of people in the world.

The treatment involves destroying the mucous membrane in the small intestine and causing a new one to develop. Scientists believe that there is a link between the nutrient absorption in the small intestine – a process in which the mucous membrane plays a key part – as well as the emergence of insulin resistance. Resistance to insulin is the key mechanism of type 2 diabetes as opposed to type 1 diabetes which is characterised by an inherent lack of insulin production. To put it simply, in type 1 diabetes, there is not enough insulin to lower blood sugar levels while in type 2 diabetes, the cells in the body do not respond to normal levels of insulin, thus needing additional insulin shots.

In the hour-long procedure, a tube with a small balloon at its end is inserted through the mouth of the patient down to the small intestine. The balloon is inflated with hot water and the mucous membrane burned away by the heat. Within two weeks a new membrane develops, leading to an improvement in the patient’s health.

The trial was done on 50 patients in Amsterdam and while the sample size is quite low, the results from the trial are promising. Even a year after treatment the disease was found to be stable in most patients. “Because of this treatment the use of insulin can be postponed or perhaps prevented. That is promising.” Jacques Bergman, a Professor of Gastroenterology at Amsterdam UMC said.

Another advantage of this procedure is that it is relatively pain-free. Bergman told the Dutch broadcaster Nederlandse Omroep Stichting further about the trial, “With those people we see a spectacular improvement in blood sugar levels one day after the operation, before they even lose one kilo, which has put us on the track.”

Bergman also speculated on the possible future for this treatment saying, “Because the question now is whether this is a permanent treatment, or whether it is something that you have to keep repeating – something that in theory should be possible. We looked at whether we could stop their insulin, which is still ongoing, but the first results are truly spectacular, with the lion’s share of patients no longer using insulin after this treatment.”

The new discovery initially seems most suitable for patients who are already on oral pills for diabetes but whose sugar levels are not under control – at least enough for doctors to prescribe insulin injections. Apart from dispensing with insulin injections, researchers claim that those treated could benefit from a lower risk of other co-morbidities like cardiovascular disease and kidney disease.

Further trials are being conducted and a larger study of 100 people is proposed with patient recruitment already underway but researchers who presented the findings at a conference in Vienna are both cautious and jubilant at the early results of their trials.

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