Most Read Articles
Pearl Toh, 31 Dec 2019
Adding the neuraminidase inhibitor oseltamivir to usual care speeds up recovery from influenza-like illness by a day compared with usual care alone, with even greater benefits seen in older, sicker patients with comorbidities, according to the ALIC4E study.
23 Dec 2019
At a Menarini-sponsored symposium held during the Asian Pacific Society Congress, renowned cardiologist Prof John Camm provided the latest evidence for chronic stable angina with or without concomitant diseases, with a special focus on the antianginal agent ranolazine and combination therapies. The event was chaired and moderated by Dr Dante Morales from the University of the Philippines College of Medicine.
Pearl Toh, 5 days ago
Obeticholic acid significantly improves fibrosis and disease activity in patients with nonalcoholic steatohepatitis (NASH), a chronic liver disease currently with no approved therapy, according to an interim analysis of the landmark REGENERATE* study.
6 days ago
Testosterone treatment may slightly improve sexual functioning and quality of life in men without underlying organic causes of hypogonadism, but it offers little to no benefit for other common symptoms of ageing, according to a study. In addition, long-term efficacy and safety of this therapy remain unknown.

Duodenal mucosal resurfacing improves glucose control in suboptimally managed T2D

Jairia Dela Cruz
26 Nov 2019

Duodenal mucosal resurfacing (DMR) proves to be a feasible and safe endoscopic procedure in type 2 diabetes (T2D) patients with suboptimal response to oral glucose-lowering medications, conferring durable improvements in glycaemic parameters and liver transaminase levels, as shown in a study.

“DMR can elicit clinically relevant improvement in glycaemic control without the anatomical disruption seen in bariatric surgery. Absolute mean HbA1c at 24 weeks and 12 months was 10 mmol/mol (0.9 percent) lower compared with baseline. This improvement is comparable with that seen in studies adding additional pharmacological agents at this stage of diabetes management,” the investigators said.

In the current open-label study, a total of 46 T2D patients (body mass index, 24–40 kg/m2; HbA1c, 59–86 mmol/mol [7.5–10.0 percent]) underwent DMR. All patients were on oral glucose-lowering medication, which was maintained for at least 24 weeks after the procedure.

DMR was completed in 37 patients (80 percent) within a mean of 82 minutes. Reasons for incomplete procedure included catheter failure (n=4; 9 percent), a difficult procedure in terms of tracking and positioning the catheter (n=3; 7 percent), duodenal tortuosity (n=1; 2 percent), or inadequate lifting (n=1; 2 percent). Mean duration of hospitalization after DMR was 0.78 day. [Gut 2019;doi:10.1136/gutjnl-2019-318349]

There were 54 DMR-related adverse events (AEs) documented in 24 patients (52 percent), with 81 percent of these events being mild in severity. There was one procedure-related serious AE reported concerning a patient with general malaise, mild fever (38° C) and increased C-reactive protein (CRP) level on the first day after DMR; the fever resolved within 24 hours, and CRP level normalized within 3 days. None of the patients developed unanticipated AEs.

In terms of efficacy, DMR produced improvements in HbA1c (−10 mmol/mol [−0.9 percent]; p<0.001), fasting plasma glucose (−1.7 mmol/L; p<0.001), Homeostatic Model Assessment for Insulin Resistance (−2.9; p<0.001), weight (−2.5 kg; p<0.001) and hepatic transaminase levels at week 24 after the procedure. These beneficial effects persisted at 12 months. Notably, the change in HbA1c did not correlate with weight loss.

Meanwhile, Diabetes Treatment Satisfaction Questionnaires scores increased by 11.8 at 24 weeks and by 12.7 at 12 months, pointing to a large and clinically relevant increase in diabetes treatment satisfaction.

“The duodenum has become a metabolic treatment target through bariatric surgery learnings and the specific observation that bypassing, excluding or altering duodenal nutrient exposure elicits favourable metabolic changes,” the investigators noted.

A novel endoscopic procedure that involves catheter-based circumferential mucosal lifting followed by hydrothermal ablation of duodenal mucosa, DMR may have a role as adjuvant or alternative approach to pharmacological treatment in the contemporary diabetes treatment spectrum, according to the investigators.

The present data form “the requisite solid foundation for further research, and controlled studies are currently under way,” they added.

Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Doctor - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Pearl Toh, 31 Dec 2019
Adding the neuraminidase inhibitor oseltamivir to usual care speeds up recovery from influenza-like illness by a day compared with usual care alone, with even greater benefits seen in older, sicker patients with comorbidities, according to the ALIC4E study.
23 Dec 2019
At a Menarini-sponsored symposium held during the Asian Pacific Society Congress, renowned cardiologist Prof John Camm provided the latest evidence for chronic stable angina with or without concomitant diseases, with a special focus on the antianginal agent ranolazine and combination therapies. The event was chaired and moderated by Dr Dante Morales from the University of the Philippines College of Medicine.
Pearl Toh, 5 days ago
Obeticholic acid significantly improves fibrosis and disease activity in patients with nonalcoholic steatohepatitis (NASH), a chronic liver disease currently with no approved therapy, according to an interim analysis of the landmark REGENERATE* study.
6 days ago
Testosterone treatment may slightly improve sexual functioning and quality of life in men without underlying organic causes of hypogonadism, but it offers little to no benefit for other common symptoms of ageing, according to a study. In addition, long-term efficacy and safety of this therapy remain unknown.