Intestinal modification for glucose control

A lot of research is being done on the effect of the duodenum on diabetes control.

The duodenum is the first part of the small intestine. Food empties from the stomach into the duodenum and then continues down the intestine. When a type of gastric bypass called Roux-en-Y is done, the duodenum is bypassed. And because glucose control improves after this operation, even before the patient has lost any weight, some researchers wondered if something produced by the duodenum was controlling blood glucose levels.

Various approaches to deal with this have been tried.

One, called he duodenal-jejunal sleeve bypass, or EndoBarrier, is a removable plastic tube that is implanted endoscopically. The tube prevents nutrients from contacting the duodenum.

The EndoBarrier has been used outside the United States with positive results, but preliminary US studies were terminated after a higher-then-expected number of liver abscesses, and some other countries have also terminated their approval of the device. Efforts to revive use of the device are underway.

The second procedure, called duodenal mucosa resurfacing, or DMR, introduces a heated balloon into the duodenum. The company says the heated water modifies the cells of the duodenum in a positive way to reduce hemoglobin A1c levels and markers of insulin resistance. It is approved in Europe but not yet in the United States.

And the third procedure uses a pill that releases substances that temporarily coat the duodenum. The active ingredient is sucralfate (Carafate), which is already approved for control of ulcers. The researchers have further engineered the sucralfate (called LuCI for luminal coating of the intestine) so that it adheres to the intestine even when it's not acidic, because normal intestine is not as acidic as ulcers. After a 24 hours, the LuCI dissipates.

Because the LuCI coats the intestine, nutrients are absorbed more slowly, and this can reduce glucose peaks, the researchers say.

So far, research has been in animals, and this treatment has not yet been approved by the FDA.

So none of these new procedures sound perfect, but it's a new approach that sound promising, and maybe new creative approaches to altering nutrient-duodenum contact will be developed.