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Minimally invasive procedure may free Type 2 diabetics from insulin

A small study suggests that a new procedure that treats part of the intestine just beyond the stomach may allow people with type 2 diabetes to safely stop taking insulin.

The procedure — which resurfaces the duodenum — was combined with a popular kind of diabetes medication called GLP-1 receptor agonists — such as Victoza, Trulicity, Ozempic — and counseling on lifestyle factors, such as nutrition and physical activity.

Six months after treatments began, three-quarters of participants taking insulin no longer needed it. The amount of fat stored in their livers dropped from 8% to less than 5%.

“The duodenum harbors a broad potential for the treatment of type 2 diabetes and this combination treatment could be a game-changing approach in the treatment of type 2 diabetes and the metabolic syndrome,” said lead researcher Dr. Suzanne Meiring, of Amsterdam University Medical Center in the Netherlands.

This preliminary study included 16 patients, all of whom underwent Duodenal Mucosal Resurfacing, or DMR. There was no placebo group or medication-only group for comparison. The study was funded by Fractyl Laboratories, which developed the procedure.

DMR is a minimally invasive procedure that relies on an endoscope — a narrow, flexible tube containing a light and video camera that lets your doctor see inside the body. The endoscope may also carry special tools for treatment. The tube is threaded down the throat into the digestive system.

In DMR, the endoscope is guided to the duodenum, where doctors then resurface, or ablate, its lining. Meiring said it’s not yet clear why the procedure works.

“We think the effects result from a combination of changes that occur when the duodenal mucosa is ablated and rejuvenated,” she said. “We think that changes in hormonal signaling, including the gut hormone GLP-1, bile acid compositions and the microbiome play an important role.”

The 16 participants had type 2 diabetes for an average 11 years. On average, they had been on insulin just under three years. None had taken a GLP-1 receptor agonist before the study.

At the outset, their average A1C levels — an estimate of blood sugar levels over two to three months — were under 8%. After 12 months, the average fell to 6.7%. For most adults, the American Diabetes Association recommends aiming for an A1C below 7%.

After the DMR procedure, patients were given a specific diet for two weeks. After that, they began taking the GLP-1 receptor agonist medication.

Meiring said researchers added the drug because it also targets the duodenum. They hoped it would boost the effects of DMR, “possibly even causing a synergistic effect,” she said.

She said she doesn’t think the positive effects in this study stem from just the drug treatment. Other studies have shown that about 10% of people who start GLP-1 therapy are able to get off insulin, Meiring said. In this study, 75% of those taking insulin were able to stop.

Participants who weren’t insulin-free after 12 months needed only about half the insulin they required before the procedure.

Could Type 1 Diabetes Begin in Utero?

Infants might develop type 1 diabetes in the first 6 months of life and seems to be unrelated to known genetic risk factors; rather, it appears linked to low birth weight, say UK researchers.

They believe the discovery could mean the disease starts in utero.

Others are skeptical, however.

The team studied 166 infants with diabetes diagnosed before 6 months of age and compared them to babies with the more common neonatal diabetes and children diagnosed with type 1 diabetes at older ages.

The combination of high type 1 diabetes genetic risk score (T1D-GRS), presence of islet-specific autoantibodies, and evidence of a rapid loss of insulin secretion all suggest that the infants had type 1 diabetes.

And notably, they all had a lower median birth weight than international reference standards.

“This study proves that type 1 diabetes can present in the first few months of life, and in a tiny subset of infants may even begin before birth,” lead author Matthew B. Johnson, PhD, Institute of Biomedical and Clinical Science, University of Exeter Medical School, UK, said in a press release from Diabetes UK, which cofunded the research.

“We also found that diabetes diagnosed so young was associated with rapid progression to complete destruction of insulin producing beta cells,” he added.

Senior author Richard A. Oram, BMBCh, PhD, also from the Institute of Biomedical and Clinical Science, said the team now plans to study the immune system of the infants in greater detail. The hope is this will “help explain how it is possible for type 1 diabetes to develop so early and whether these insights could open up new ways to prevent or treat the condition in the future,” he added.

The research was published online on October 8 in Diabetologia.

Elizabeth Robertson, PhD, director of research at Diabetes UK, said: “These important findings rewrite our understanding of when the condition can strike and when the immune system can start to go wrong.”

“We now need to piece together how and why type 1 diabetes can develop at such a young age,” which could “unlock crucial insights into causes of type 1 diabetes more generally…and will be essential to develop treatments that stop or prevent this life-altering condition in babies,” she observed.

No Direct Evidence That Type 1 Diabetes Starts in the Womb

Asked to comment, Mikael Knip, MD, PhD, told Medscape Medical News that the study is “interesting” but the findings are “not perhaps as new as they claim,” nevertheless the research consists of “a large series of infants” and it is a “well done study.”

However, Knip doubts that type 1 diabetes develops in the womb.

“We have never seen diabetes-associated autoantibodies in a newborn infant in cord blood, except for those where the mother tests positive for autoantibodies,” said Knip, of the Children’s Hospital, University of Helsinki, Finland.

“These are IgG antibodies and that [type of immune reaction] is conferred from the maternal circulation to the fetal circulation during pregnancy, but we have never seen

Treatment Reverses Young Man’s Type 1 Diabetes. Will It Last? | Health News

By Serena Gordon
HealthDay Reporter

(HealthDay)

WEDNESDAY, Oct. 7, 2020 (HealthDay News) — After starting a drug that’s officially approved to treat a type of blood cancer, a young man with type 1 diabetes was able to stop using insulin.

He’s been off insulin since August 2018 — more than two years.

Dr. Lisa Forbes — his doctor and co-author of a letter describing his case in the Oct. 8 issue of the New England Journal of Medicine — stopped short of calling the drug a cure for type 1 diabetes.

But Forbes, an assistant professor of pediatrics, immunology, allergy and rheumatology at Baylor College of Medicine in Houston, said the patient’s diabetes appears to have been reversed. She hopes it will stay that way as long as he keeps taking the oral medication called ruxolitinib (Jakafi). It’s in a class of medications known as JAK inhibitors.

Whether this drug can help others with type 1 diabetes isn’t yet known. This patient had a genetic mutation that ruxolitinib is known to work on. Forbes said it’s not clear if other people with type 1 diabetes also have this specific genetic mutation.

Type 1 diabetes is believed to be an autoimmune disease, though the exact cause is unknown. It develops when the immune system mistakenly attacks insulin-producing beta cells in the pancreas. Insulin is a hormone that ushers the sugars from foods into the body’s cells to be used as fuel.

People with type 1 diabetes produce little to no insulin and must take multiple daily injections of insulin (or use an insulin pump) to survive. No treatments are approved for reversing type 1 diabetes.

At 15, Forbes’ patient had been experiencing chronic yeast infections (of skin, nails, mouth and throat), chronic diarrhea, oral and rectal ulcers, recurrent sinus and lung infections and another autoimmune condition called hypogammaglobulinemia. At 17, he was diagnosed with type 1 diabetes.

Because he had multiple conditions, his doctors ordered whole genome sequencing to see if they could pinpoint a root cause. They saw one particular genetic mutation and thought ruxolitinib might help. He started the drug nine months after being diagnosed with type 1 diabetes.

“The drug had an unbelievable effect on his type 1 diabetes,” Forbes said. “A year after starting ruxolitinib, we took him off insulin, and he’s been insulin-free ever since.”

The patient is in college now, and Forbes said he calls the drug a “game-changer” because it’s a pill and so easy to take.

Forbes said this case provides potentially important information into a pathway that leads to type 1 diabetes. But more research is needed, she added.

Because ruxolitinib acts on the immune system, patients have a higher risk of certain infections. And their white blood cells, liver function and kidney function have to be checked every few months, according to Forbes.

She isn’t the only one excited about the potential of JAK inhibitors in type 1 diabetes.

JDRF (formerly the Juvenile Diabetes Research Foundation) has been funding research into

Improving blood sugar in Type 2 diabetes improves cognitive scores, study says

Oct. 5 (UPI) — Controlling blood sugar levels helped people with Type 2 diabetes who were overweight improve cognitive scores, but losing weight, exercise had mixed results, a new study shows.

More than a quarter of U.S. adults 65 or older have Type 2 diabetes, which doubles the risk of cognitive impairment and dementia, including Alzheimer’s disease, according to a statement from the Pennington Biomedical Research Center.

“It’s important to properly control your blood sugar to avoid the bad brain effects of your diabetes,” said study author Owen Carmichael said in a statement.

“Don’t think you can simply let yourself get all the way to the obese range, lose some of the weight, and everything in the brain is fine,” said Carmichael, a professor and director of Biomedical Imaging at Pennington Biomedical Research Center. “The brain might have already turned a corner that it can’t turn back from.”

The study, published in the latest issue of The Journal of Clinical Endrocrinology and Metabolism, analyzed whether markers such as body weight, blood sugar control, and physical activity would be associated with improved cognition in 1,089 participants, age 45 to 76, who have Type 2 diabetes.

Researchers theorized that greater improvements in all three markers would lead to better cognitive test scores, but that turned out to be only partially true. While reducing blood sugar levels improved test scores, losing more weight and exercising more didn’t always do so.

“Every little improvement in blood sugar control was associated with a little better cognition,” Carmichael said. “Lowering your blood sugar from the diabetes range to prediabetes helped as much as dropping from prediabetes levels to the healthy range.”

Meanwhile, results from weight loss varied depending on the mental skill, according to Carmichael. More weight loss improved participants short-term memory, planning, impulse control, attention and the ability to switch tasks, but verbal learning and overall memory still declined.

“The results were worse for people who had obesity at the beginning of the study,” he added.

Similarly, Carmichael said the study showed that increasing physical activity also benefited people who were overweight more than people with obesity.

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The MarketWatch News Department was not involved in the creation of this content.

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