New Surgery May Eliminate the Need for Insulin for People with Type 2 Diabetes

Insulin injections can be expensive and time-consuming, but they’re necessary for many people with diabetes. However, a recent study suggests that many people with type 2 diabetes could opt to have a one-time surgery that could save them from needing insulin injections for the rest of their lives.

The small study, funded by Fractyl Laboratories, involved 16 participants who all have type 2 diabetes. The group has had diabetes on average for 11 years and had been on insulin for an average of just under three years. None of them had taken GLP-1 receptor agonists before the study.

All participants underwent a new procedure called Duodenal Mucosal Resurfacing (DMR), in which an area of the intestine called the duodenum is resurfaced by means of an endoscope threaded down the throat and into the digestive system.

Photo: Adobe Stock/romaset

All of the participants took GLP-1 receptor agonists such as Victoza, Trulicity, or Ozempic starting two weeks after surgery, as these medications also target the duodenum. They also received counseling on nutrition and physical activity.

After six months, three-quarters of the participants who were taking insulin no longer needed it and were able to safely transition away from it. Participants who were not able to quit taking insulin after 12 months were at least able to cut down on their dose by half.

The average amount of fat stored in participants’ livers decreased from 8 percent to less than 5 percent. Their average A1C levels also fell from about 8 percent to 6.7 percent, and their BMIs dropped from almost 30 to a near-normal 25.5 over 12 months.

Photo: Adobe Stock/Studio Romantic

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“The duodenum harbors a broad potential for the treatment of type 2 diabetes and this combination treatment could be a game-changing approach in the treatment of type 2 diabetes and the metabolic syndrome,” says lead researcher Dr. Suzanne Meiring of the Amsterdam University Medical Center in the Netherlands.

Meiring says it’s not yet clear exactly why the procedure works for people with type 2 diabetes desiring to get off insulin.

“We think the effects result from a combination of changes that occur when the duodenal mucosa is ablated and rejuvenated,” she says. “We think that changes in hormonal signaling, including the gut hormone GLP-1, bile acid compositions, and the microbiome play an important role.”

Photo: Adobe Stock/salomonus_

So far, it does not appear that there are any procedure-related side effects that people considering the surgery need to be concerned about. However, more research is still needed.

“This is a simple, single procedure that seems to have amazingly positive results,” says Dr. Akankasha Goyal, an endocrinologist at NYU Langone Health in New York City. “But, this is a small group from a homogenous population. It looks hopeful, but we need to see the larger trials. And, we need to know: how long does the procedure last?”

Dr. Mitchell Roslin, chief of obesity surgery at Lenox Hill Hospital in New York City agrees, calling the findings “very exciting” but urging caution.

Photo: Adobe Stock/Damian

“People in clinical trials are motivated to lose weight, and they change their eating habits,” Roslin says. “So the question is: Is the procedure the cause [of the changes] or is it an association? I would bet it’s an association.”

Placebo-controlled clinical trials of the DMR procedure are now starting at 35 hospitals across the globe. Researchers hope that the results will corroborate early findings so that more people with diabetes may be able to free themselves from the need for insulin.

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