Alternative treatments for type 2 diabetes and associated metabolic diseases: medical therapy or endoscopic duodenal mucosal remodelling?

Abstract

The number of patients with type 2 diabetes (T2D) worldwide is expected to increase from 463 million in 2019 to 700 million in 2045, with a prevalence of more than 10% in Europe. Besides a role for genetics, causative factors include obesity, diet high in refined sugar and fat, and sedentary lifestyle. These factors may contribute to increased hepatic and peripheral insulin resistance, and thereafter pancreatic beta cells increase their insulin production to facilitate glucose uptake. This increased demand ultimately leads to pancreatic beta cell depletion, failure and cell death, resulting in metabolic decompensation, hyperglycaemia and overt hyperglycaemia. Eventually, macrovascular and microvascular complications develop following long-standing hyperglycaemia, accounting for significant morbidity and mortality in patients with T2D. Cardiovascular events are the major cause of death in patients with T2D. Although there have been many important advances in oral and injectable medications since the millennium, overall control of blood glucose remains suboptimal in published audits from many countries and there is still a need for new treatment modalities that may impact on the management and natural history of T2D. In this review we consider emerging evidence on new techniques based on ablation of the duodenal mucosa and consider the potential place of this approach in the future management of T2D.12