A bizarre diabetes treatment seems to destroy cells lining the gut to change people’s hormonal response to food.
The technique involves putting a tube down someone’s throat and into the first part of their small intestine, called the duodenum, while they are sedated. Known as Revita, the procedure uses water heated to 75°C to kill the outermost layer of cells.
People with type 2 diabetes, which is linked with being overweight, often have overgrowth of the cells lining the duodenum. This may result from years of unhealthy eating, says Harith Rajagopalan at Fractyl, the firm behind the procedure.
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When we eat, cells in the duodenum make a hormone called gastric inhibitory polypeptide (GIP), which triggers several other hormones that control how we metabolise nutrients. GIP production is enhanced in people with diabetes. Killing some of the excess gut cells should make the person’s hormonal response to food more like that of someone without diabetes, he says.
To date, about 300 people in the UK, three other European countries and Brazil have had the intervention. Of these, 34 people have been studied for two years, and their levels of HbA1c, a marker of long-term blood glucose levels, fell from 8.5 to 7.5 per cent. Despite this improvement, the people would still be classed as having diabetes.
In a randomised 70-person trial, where half the participants had a sham version of the treatment, those who got the real thing had improvements in glucose control and markers of liver health after three months. The figures were due to be presented at the Endo 2020 conference in San Francisco last week, which was cancelled.
The procedure tends to result in a small weight loss of about 3 kilograms, but it won’t be marketed as a treatment for obesity. “It’s a metabolic reset rather than a weight loss procedure,” says Rajagopalan.
If people continue eating an unhealthy diet afterwards, their gut cells may overgrow again but that is likely to take several years, he says. “This procedure could be repeated in time if necessary.”
Roy Taylor at Newcastle University, UK, says the mechanism behind the improvement in glucose control is unclear, because it could have resulted from the weight loss. “The jury is very much out.”
“It is exciting to see innovative treatments like this in the pipeline, but the research is still at an early stage, and there are many important questions still to answer,” says Faye Riley at Diabetes UK. “We look forward to seeing more robust clinical trial evidence, and untangling more about how this approach works.”
There is already the option of weight-loss surgery for people who are very overweight and can’t slim down through diet and exercise. One method is a gastric bypass, where the stomach is made smaller and connected to the lower small intestine so food avoids passing through the duodenum. Another option is to put a thin sleeve inside the duodenum blocking contact between its cells and food.
Both methods are thought to work by cutting absorption of food, but they may also change the duodenum’s release of hormones, says Rajagopalan.
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