Long-term effects of duodenal mucosal resurfacing and liraglutide on glycaemic control in patients with type 2 diabetes
Introduction Endoscopic duodenal mucosal resurfacing (DMR) induces mucosal regeneration through hydrothermal ablation. Studies have shown that DMR improves hyperglycaemia in patients with type 2 diabetes. The INSPIRE study (n=16) aimed to eliminate insulin by combining DMR with a glucagon-like pepti...
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| Series: | BMJ Nutrition, Prevention & Health |
| Online Access: | https://nutrition.bmj.com/content/early/2025/01/03/bmjnph-2024-001006.full |
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| author | Max Nieuwdorp Annieke C G van Baar Jacques J G H M Bergman Celine B E Busch Julia Rubingh |
| author_facet | Max Nieuwdorp Annieke C G van Baar Jacques J G H M Bergman Celine B E Busch Julia Rubingh |
| author_sort | Max Nieuwdorp |
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| description | Introduction Endoscopic duodenal mucosal resurfacing (DMR) induces mucosal regeneration through hydrothermal ablation. Studies have shown that DMR improves hyperglycaemia in patients with type 2 diabetes. The INSPIRE study (n=16) aimed to eliminate insulin by combining DMR with a glucagon-like peptide-1 receptor agonist (GLP-1RA). At 18 months, 53% of patients were off insulin with adequate glycaemic control. This retrospective analysis evaluates long-term effects of DMR and GLP-1RA.Research design and methods Fourteen patients gave consent for the prolonged follow-up and data on glycaemic control, medication and DMR satisfaction were obtained via general practitioners. Primary endpoint was the number of patients off insulin with glycaemic control (haemoglobin A1c (HbA1c) ≤58 mmol/mol (7.5%)) at 4 years post DMR. Secondary endpoints were changes in HbA1c, fasting plasma glucose (FPG), weight, body mass index (BMI), use of glucose-lowering medications, treatment satisfaction and willingness to undergo DMR retreatment.Results Nine out of 14 patients (64%) were off insulin at 4 years. Of these, five patients (36% of study population) were adequately controlled. HbA1c and FPG did not change significantly, whereas BMI decreased at 3 and 4 years. Among the responders at 12 months, there was 80% durability at 4 years. Patients rated the DMR procedure 9 out of 10 and 86% were willing to undergo DMR retreatment.Conclusions Despite a stable number of patients remaining off insulin, a decrease in patients with adequate glycaemic control was observed. This suggests a slightly fading long-term DMR effect on glycaemia. High patient satisfaction and willingness for DMR retreatment indicate a promising avenue for further research. |
| format | Article |
| id | doaj-art-bc01a5fdff9546ea849fadf0835ae3e6 |
| institution | Kabale University |
| issn | 2516-5542 |
| language | English |
| publisher | BMJ Publishing Group |
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| series | BMJ Nutrition, Prevention & Health |
| spelling | doaj-art-bc01a5fdff9546ea849fadf0835ae3e62025-01-03T11:40:13ZengBMJ Publishing GroupBMJ Nutrition, Prevention & Health2516-554210.1136/bmjnph-2024-001006Long-term effects of duodenal mucosal resurfacing and liraglutide on glycaemic control in patients with type 2 diabetesMax Nieuwdorp0Annieke C G van Baar1Jacques J G H M Bergman2Celine B E Busch3Julia Rubingh4Department of Vascular Medicine, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands1 Gastroenterology and Hepatology, Amsterdam UMC Location AMC, Amsterdam, The Netherlands2 Department of Gastroenterology and Hepatology, Amsterdam UMC—Locatie AMC, Amsterdam, North Holland, The NetherlandsDepartment of Gastroenterology and Hepatology, Amsterdam UMC Location VUmc, Amsterdam, Noord-Holland, NetherlandsDepartment of Gastroenterology and Hepatology, Amsterdam UMC Location VUmc, Amsterdam, Noord-Holland, NetherlandsIntroduction Endoscopic duodenal mucosal resurfacing (DMR) induces mucosal regeneration through hydrothermal ablation. Studies have shown that DMR improves hyperglycaemia in patients with type 2 diabetes. The INSPIRE study (n=16) aimed to eliminate insulin by combining DMR with a glucagon-like peptide-1 receptor agonist (GLP-1RA). At 18 months, 53% of patients were off insulin with adequate glycaemic control. This retrospective analysis evaluates long-term effects of DMR and GLP-1RA.Research design and methods Fourteen patients gave consent for the prolonged follow-up and data on glycaemic control, medication and DMR satisfaction were obtained via general practitioners. Primary endpoint was the number of patients off insulin with glycaemic control (haemoglobin A1c (HbA1c) ≤58 mmol/mol (7.5%)) at 4 years post DMR. Secondary endpoints were changes in HbA1c, fasting plasma glucose (FPG), weight, body mass index (BMI), use of glucose-lowering medications, treatment satisfaction and willingness to undergo DMR retreatment.Results Nine out of 14 patients (64%) were off insulin at 4 years. Of these, five patients (36% of study population) were adequately controlled. HbA1c and FPG did not change significantly, whereas BMI decreased at 3 and 4 years. Among the responders at 12 months, there was 80% durability at 4 years. Patients rated the DMR procedure 9 out of 10 and 86% were willing to undergo DMR retreatment.Conclusions Despite a stable number of patients remaining off insulin, a decrease in patients with adequate glycaemic control was observed. This suggests a slightly fading long-term DMR effect on glycaemia. High patient satisfaction and willingness for DMR retreatment indicate a promising avenue for further research.https://nutrition.bmj.com/content/early/2025/01/03/bmjnph-2024-001006.full |
| spellingShingle | Max Nieuwdorp Annieke C G van Baar Jacques J G H M Bergman Celine B E Busch Julia Rubingh Long-term effects of duodenal mucosal resurfacing and liraglutide on glycaemic control in patients with type 2 diabetes BMJ Nutrition, Prevention & Health |
| title | Long-term effects of duodenal mucosal resurfacing and liraglutide on glycaemic control in patients with type 2 diabetes |
| title_full | Long-term effects of duodenal mucosal resurfacing and liraglutide on glycaemic control in patients with type 2 diabetes |
| title_fullStr | Long-term effects of duodenal mucosal resurfacing and liraglutide on glycaemic control in patients with type 2 diabetes |
| title_full_unstemmed | Long-term effects of duodenal mucosal resurfacing and liraglutide on glycaemic control in patients with type 2 diabetes |
| title_short | Long-term effects of duodenal mucosal resurfacing and liraglutide on glycaemic control in patients with type 2 diabetes |
| title_sort | long term effects of duodenal mucosal resurfacing and liraglutide on glycaemic control in patients with type 2 diabetes |
| url | https://nutrition.bmj.com/content/early/2025/01/03/bmjnph-2024-001006.full |
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