The new treatment that could reverse type 2 diabetes and banish insulin jabs - as researchers hail 'exciting' find

A blast of steam is being tested as a treatment for type 2 diabetes that could potentially banish the need for insulin jabs.

The therapy involves hot vapour being fired at the lining of the duodenum – the first part of the small intestine – to deliberately damage it.

Research shows that people with type 2 diabetes whose diet is high in carbohydrates, fats and sugar often have a much thicker duodenum lining (or mucosa).

Scientists believe that high levels of blood sugar and the subsequent release of the hormone insulin causes signals in the body to promote cell and tissue growth. This causes the lining to become engorged and less sensitive to insulin – leading to type 2 diabetes.

But following the new treatment, once the top surface of the duodenum has ‘regenerated’, it can become more sensitive once again to insulin, with patients’ blood sugar levels returning to normal.

The results of a clinical trial in centres across Europe and Brazil, published in the journal Diabetes Research and Clinical Practice in 2022, found that after two years, patients’ blood sugar levels were ‘significantly reduced’ and more than 50 per cent of them reduced their diabetes medications, or kept them constant (rather than having to increase the dose).

In a small trial involving a newer form of the treatment, given to 20 patients in Chile, it was found that, nine months after treatment, all of them have been able to stop their insulin jabs (although some are still on their oral medication), as recently reported in GIE, the journal of the American Society for Gastrointestinal Endoscopy.

About one in four of the estimated 5.8 million people in the UK diagnosed with type 2 diabetes relies on insulin injections to manage their condition, according to the charity Diabetes UK.

This new approach – destroying the duodenum lining – follows on from the discovery that weight-loss surgery (where the stomach is made smaller) can also dramatically improve blood-sugar control.

‘What we’ve noticed over the past few decades is that when people underwent gastric bypass surgery to help them lose weight, it can also hugely improve their type 2 diabetes,’ explains Arin Saha, a consultant in general, upper gastrointestinal and bariatric surgery at Calderdale and Huddersfield NHS Trust.

‘A diabetic patient would come in for their surgery on Monday, say, and after having the gastric bypass surgery, by Tuesday their need for diabetic medication would be virtually gone.

‘Because the effect of this surgery was so rapid, it could not be attributed to weight loss.

‘So researchers began looking at another explanation. We found that nutrients were only now being absorbed in the small bowel, which meant glucose levels were more normal afterwards.’

It’s thought the duodenum plays an important role in ‘signalling’ to the body that nutrients coming from the stomach need absorbing.

But, as Mr Saha explains, the impaired surface of the duodenum may mean this process can no longer happen as efficiently.

‘For whatever reason there’s a dysfunction of the duodenum which occurs in people with type 2 diabetes.’

‘When you think about diabetes you normally think of the liver producing glucose and pancreas producing insulin. But now there’s another organ, the duodenum, which we think plays an important part in causing someone with diabetes to produce more glucose and not enough insulin to deal with it.’

Based on their understanding of the role of the duodenum, researchers began looking for a less extreme way than gastric bypass surgery to gain the same benefits. At first they focused on ‘resurfacing’ the duodenum using a procedure called duodenal mucosal ablation.

Here a 15cm long section of the duodenum lining is deliberately destroyed using a balloon-like device containing hot liquid that’s moved along the passageway.

This led to a simpler approach using technology called radio-frequency vapour ablation, where a catheter device is passed along an endoscope (a flexible tube with a tiny camera at its tip and through which surgical tools can also be inserted), releasing blasts of steam each lasting about three seconds.

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In the latest trial, which started in 2023, involving patients in Chile but overseen by researchers at the private Cleveland Clinic in London, a 60cm section of the duodenum was treated – this length mimics how much of the duodenum is bypassed during a gastric bypass operation, says Dr Rehan Haidry, a gastroenterologist and interventional endoscopist at the Cleveland Clinic, who is leading the trial.

The procedure takes about half an hour and uses liquid heated to 90C, explains Dr Haidry.

‘The patient goes home around two hours later and the lining is healed around four weeks later – so far, patients on the trial have not reported any complications, discomfort or pain.’

While the full results of the study should be published next year, ‘patients have gone from an average HbA1c [a way of measuring average blood sugar levels over two to three months] of around 9.3 per cent to 7.6 per cent [an ideal reading is under 6.5 per cent].’

Currently the treatment is not available in the UK.

A review published last year by the National Institute for Health and Care Excellence looking at existing studies into duodenal mucosa resurfacing, recommended that for now it should only be done as part of a formal research study.

Dr Haidry is now seeking approval for a UK trial, which he hopes will happen next year.

Commenting on the approach, Mr Saha told Good Health: ‘There’s excitement about this new way of possibly tackling diabetes and so the results of more studies will be very interesting.

‘This could be another tool to tackle the growing number of people with type 2 diabetes, which would definitely be welcome.’