Miracle cure? New procedure could spell the end of insulin injections for type 2 diabetics
Researchers have developed a new treatment approach for type 2 diabetes that could potentially eliminate the need for insulin therapy in a majority of patients, according to findings presented at UEG Week 2024 in Vienna.
Innovative combination therapy yields impressive results
A first-in-human study has demonstrated that combining a novel procedure called ReCET (Re-Cellularization via Electroporation Therapy) with semaglutide administration resulted in 86% of participants no longer requiring insulin therapy. This promising approach addresses the growing need for alternative treatment strategies in type 2 diabetes management.
Type 2 diabetes (T2D) affects an estimated 422 million people worldwide, with obesity recognised as a significant risk factor. While insulin therapy is a common management strategy for T2D, it can lead to undesirable side effects such as weight gain, further complicating diabetes control.
The study, presented on 14 October 2024 at UEG Week, included 14 participants aged 28 to 75 years with body mass indices ranging from 24 to 40 kg/m². Each participant underwent the ReCET procedure under deep sedation, followed by a two-week isocaloric liquid diet. Subsequently, semaglutide was gradually titrated up to 1mg/week.
Sustained glycaemic control without insulin
At the 6- and 12-month follow-ups, 12 out of 14 participants (86%) no longer required insulin therapy. This success was maintained through the 24-month follow-up, with all patients in this group maintaining glycaemic control as evidenced by HbA1c levels remaining below 7.5%.
Dr Celine Busch, lead author of the study, said: “These findings are very encouraging, suggesting that ReCET is a safe and feasible procedure that, when combined with semaglutide, can effectively eliminate the need for insulin therapy.”
The maximum dose of semaglutide was well-tolerated by 93% of participants, with only one individual unable to increase to the maximum dose due to nausea. All patients successfully completed the ReCET procedure, and no serious adverse effects were reported.
Addressing the root cause of T2D
One of the key advantages of this novel approach is its potential to modify the disease process itself. Dr Busch explained: “Unlike drug therapy, which requires daily medication adherence, ReCET is compliance-free, addressing the critical issue of ongoing patient adherence in the management of T2D. In addition, the treatment is disease-modifying: it improves the patient’s sensitivity to their own (endogenous) insulin, tackling the root cause of the disease, as opposed to currently available drug therapies, that are at best disease-controlling.”
The ReCET procedure
The ReCET procedure is an endoscopic treatment that employs electroporation to ablate the duodenal mucosa. This method creates small, irreversible holes in cell membranes, leading to apoptosis, or natural cell death. The procedure can be precisely controlled for depth and avoids generating heat, thereby preventing damage to deeper wall layers – a common challenge with standard endoscopic ablation techniques.
While the exact mechanism by which ReCET enhances the body’s sensitivity to endogenous insulin remains under investigation, the initial results are promising. The researchers are now planning larger randomised controlled trials to further validate these findings.
The EMINENT-2 trial
Dr Busch added: “We are currently conducting the EMINENT-2 trial with the same inclusion and exclusion criteria and administration of semaglutide, but with either a sham procedure or ReCET. This study will also include mechanistic assessments to evaluate the underlying mechanism of ReCET.”
The EMINENT-2 trial is expected to provide more robust evidence on the efficacy of the ReCET procedure combined with semaglutide, as well as insights into its mode of action. This could potentially pave the way for a paradigm shift in T2D management, offering a treatment option that addresses the underlying insulin resistance rather than simply managing symptoms.
As the global prevalence of T2D continues to rise, driven in part by increasing obesity rates, the need for effective, long-term management strategies becomes ever more pressing. If further studies confirm the efficacy and safety of this novel approach, it could offer new hope for millions of people living with T2D, potentially freeing them from the burden of daily insulin injections and improving their quality of life.
