The Future of Diabetes Care: Innovative Endoscopic Procedure May Eliminate the Need for Insulin

A daily reality that millions of people around the world face is a type 2 diabetes diagnosis and the consequential lifestyle adaptations that accompany it.

Countless finger pricks, multiple insulin injections throughout the day, and the constant worry of maintaining balanced blood sugar levels—these experiences are central to the challenge of managing this widespread chronic condition. But maybe not for long.

The Breakthrough ReCET Procedure

In the sphere of medical advancements, the dawn of a new era in diabetes treatment seems to be on the horizon. The EMINENT study, recently presented during Digestive Disease Week (DDW) 2023, has put forward an exciting prospect: an endoscopic technique that may mitigate, or even eliminate, the need for insulin in patients with type 2 diabetes.

This technique, termed Re-cellularization via Electroporation Therapy (ReCET), employs electroporation—a method that uses an electric pulse to make temporary pores in cell membranes.

In the case of ReCET, this procedure is carried out on the mucosal lining of the small intestine, resulting in a disruption that triggers natural cell death in the superficial layer. However, unlike other ablation methods, this procedure doesn’t damage the intestinal tissue with extreme heat or cold.

How Does ReCET Work?

The fundamental idea behind ReCET is to rejuvenate the duodenal lining of the small intestine, thus potentially reducing insulin resistance, which is often at the root of type 2 diabetes.

This procedure, when combined with a GLP-1 receptor agonist called semaglutide—a medication known to boost the release of insulin – demonstrated encouraging results in the pilot study.

Safety and Feasibility of the ReCET Procedure

For any new medical intervention, its safety and ease of implementation are as crucial as its efficacy. In this regard, the EMINENT study has brought forth promising data. The ReCET procedure was carried out successfully in all the patients, without any serious adverse events related to endoscopy.

The procedure involves the use of a pulsed electric field, which can be precisely controlled and has a limited depth of penetration. This ensures that the procedure doesn’t directly cause physical damage to the mucosa, the inner lining of the intestine. Instead, it disrupts the cellular membrane of the mucosa and superficial submucosa, causing the cells to die naturally within 24 hours of the procedure. The lack of temperature increase during the procedure significantly reduces the chances of complications, making ReCET a safe, outpatient procedure.

This safety aspect, combined with the observed potential to improve glycemic control and possibly eliminate the need for insulin, makes the ReCET procedure a promising avenue in type 2 diabetes treatment. However, these results are preliminary, and more comprehensive studies are required to confirm the findings.

Preliminary Results and Future Research

The pilot study was conducted with 14 patients with type 2 diabetes who had previously relied on insulin to manage their blood sugar levels.

After the ReCET procedure and subsequent semaglutide therapy, a staggering 86% of patients were able to maintain their glycemic control without the need for insulin. There was also a significant reduction in fasting plasma glucose levels and liver fat percentage, with a trend toward improvement in other metabolic parameters.

Despite the promising results, the limited scope of the study presents challenges in differentiating between the individual impacts of ReCET and semaglutide on glycemic control. Nevertheless, the researchers are hopeful about the synergistic effect of these two approaches.

To confirm their findings, a randomized controlled trial is being planned for the future.