Research findings presented at Diabetes UK's Professional Conference (DUKPC) reveal exciting progress towards new treatments that could provide an alternative to weight loss surgery in type 2 diabetes, and tackle the immune attack in type 1 diabetes.
Temporary gut liner could be effective alternative to weight loss surgery
New research shows that a minimally invasive and temporary alternative to weight loss surgery - called the EndoBarrier gut liner - can help people with type 2 diabetes sustain weight loss and lower blood sugar levels, for at least two years after its removal.
For people living with type 2 diabetes and obesity, losing weight helps to manage blood sugar and reduce the risk of serious diabetes complications. For some, weight loss surgery, also known as bariatric surgery, can be very effective in managing both type 2 diabetes and obesity. But it’s invasive and permanent, so scientists have been searching for other options.
What is the EndoBarrier?
The EndoBarrier device is reversible and fitted with a straightforward procedure. The thin impermeable sleeve is inserted via the mouth. It lines the first 60cm of the small intestine, preventing food absorption in that area.
This is thought to change how the body processes nutrients and releases gut hormones, resulting in more efficient processing of glucose and people feeling fuller more quickly. After 12 months, the EndoBarrier is removed. It’s currently only available in a research setting.
Dr Bob Ryder, Consultant Diabetologist at Birmingham City Hospital, looked at 60 people with type 2 diabetes and obesity who had received the EndoBarrier treatment as part of a research study. They were followed up two years after they’d had the device removed.
At around 12 months after the EndoBarrier had been implanted, the 60 people experienced substantial weight loss (average 16.7kg) and significantly lower blood sugar, blood pressure and cholesterol levels.
The latest results show for the first time that two years after EndoBarrier removal:
- 53% of people were found to sustain their body weight and blood sugar level improvements
- 27% maintained some of the improvements
- 20% reverted back to where they were before the EndoBarrier treatment
- Of the 36/60 people who were using insulin prior to EndoBarrier treatment, 28% were no longer using insulin two years after its removal.
Losing weight and keeping it off is a real challenge for many people with type 2 diabetes. These results indicate that the device could be another treatment option to help people with type 2 diabetes and obesity.
But more data is needed to thoroughly assess all the benefits against the risks. A global registry of people who’ve taken part in EndoBarrier trials has been set up that will aid this.
Dr Ryder said:
“There is a worldwide pandemic of type 2 diabetes and obesity, and many people are not able to keep weight off and have blood sugar levels that are too high despite their best efforts and all available medications. For them, bariatric surgery can be effective, but demand is too great for available services and the surgery is permanent and not without risk. EndoBarrier has the advantage of being a relatively easy treatment to give, and it is not permanent as the device is removed after about a year.
“The importance of our findings to people living with type 2 diabetes is that we have shown that in our service 80% were able to maintain significant improvement 2 years after removal of EndoBarrier.”
Dr Elizabeth Robertson, Director of Research at Diabetes UK, said:
“Despite notable advances in treatment options for type 2 diabetes over the past decade, bringing blood sugars into target range and keeping them there can still be a real challenge. Healthcare professionals must work with people with type 2 diabetes to find the right approach for them, whether that involves medications, diet and exercise, or weight loss surgery.
"More type 2 treatments will mean that people with the condition will have a better opportunity of finding a treatment that suits them, so they have the best chance of a long and healthy future.”
Silencing the pancreas’ panic alarm
Elsewhere at our Professional Conference, scientists revealed they've discovered a promising way to 'mute' the panic alarm insulin-making beta cells send when they're under attack in type 1 diabetes.
One of the culprits in the immune system’s destruction of beta cells is a protein called STAT1. When it’s activated it triggers beta cells to send out an alarm, which can make the immune system’s attack worse.
A team supported by Diabetes UK and led by Professor Noel Morgan at the University of Exeter ran some experiments and found a way to interfere with this alarm system. They focused on another protein found on beta cells, called HDAC6, which plays a role in ‘talking’ to STAT1.
They studied cells in the lab and found that when they added a substance that blocks HDAC6, they were able to prevent the activation of STAT1 and quieten down the panic alarm.
They also tried out another way to reduce levels of HDAC6 in beta cells, using a technique that switches off the production of proteins being made by cells. When they replicated the type 1 immune attack in the lab, they saw this technique helped to protect beta cells and reduce the number that died by 12%.
This all means scientists have a promising new target in the immune system to home in on, paving the way to new immunotherapies that help beta cells stay quiet and stay safe in people with or at risk of type 1 diabetes.
Over 300 new research findings are being shared this week at our Professional Conference. Keep an eye out for more of our updates on the standout science.
