How Type 2 diabetes could be banished by a tiny balloon inside the gut
Published 2 Aug 2016
A new treatment for diabetes involves heating part of the intestine using a tiny balloon.
Retired university dean and part-time magistrate Russell Pearson, 61, from Loughton in Essex, was the first in the UK to have it, as he tells PAT HAGAN.
THE PATIENT
About ten years ago I noticed a gradual increase in the amount of liquid I was drinking.
Over several months I went from having a couple of teas or coffees a day and the occasional soft drink, to between eight and ten cans daily with lots of water and hot drinks.
I would often fill a bottle with a litre of squash and down it in one go and still be thirsty a few minutes later.
I had no other symptoms but knew raging thirst was a sign of diabetes, so I went to see my GP, who referred me for a blood sugar (glucose) test at nearby Whipps Cross Hospital.
This confirmed I had type 2 diabetes and I was prescribed metformin.
I was slightly shocked by my diagnosis because I have no family history of diabetes, though it wasn’t a huge surprise when I thought about it.
Although my job involved walking up to six miles a day, I led a pretty sedentary lifestyle.
I liked a Friday night drink with friends and often spent Saturday afternoon watching football. At 5ft11 and 14½ st I was at least two stone overweight.
I was advised to eat more healthily and to exercise, then had check-ups every six months.
Over the years, the amount of metformin I needed increased. By early 2015, I was on a total of 2,500mg a day — the maximum recommended dose.
At a check-up, my doctors warned there was a good chance I would soon need to start injecting insulin every day.
Last year my diabetes nurse said she was moving to University College Hospital in London and suggested I transfer there, too, as it had an outstanding reputation for gut disorders.
Because I also have Barrett’s oesophagus [damage to the cells in the oesophagus caused by chronic heartburn], I decided to switch.
Then, a few weeks later, I got invited by my consultant gastroenterologist Dr Rehan Haidry to take part in a trial for a new treatment for diabetes, called duodenal mucosal resurfacing. He said it could help me avoid insulin injections.
It involved inserting a thin tube with a balloon through my mouth and stomach, and positioning it at the top of my intestine (the duodenum). The balloon would then be filled with hot water.
The idea was that heat destroys cells on the surface which had been damaged by my diabetes, allowing new ones to grow.
This would apparently help my body produce more insulin. I didn’t fancy insulin injections so decided to give this a try.
I had the hour-long procedure in September 2015. I was heavily sedated but when I came round I felt fine, apart from slight nausea.
After an overnight stay I was discharged and put on a liquid diet for a few days to give my duodenum time to recover.
My diabetes has been gradually improving — my last reading a few weeks ago showed my blood sugar was in the perfectly healthy range.
I’ve lost two stone since the procedure and am slowly being weaned off metformin, too.
I had resigned myself to my diabetes getting worse, increasing the risk of me losing my eyesight and limbs. But this treatment has given me a new lease of life.
THE SPECIALIST
Dr Rehan Haidry is a consultant gastroenterologist at University College Hospital in London
Two and a half million people in the UK are affected by diabetes, and this figure is set to double by 2030. So there is a pressing need for new, effective treatments.
I’m a gastroenterologist and diabetes is not a condition I normally deal with. But in 2015 I was approached by a medical device company, asking if I wanted to help trial a new type of ablation therapy, where abnormal cells are destroyed using heat or electric probes inserted into the body.
The procedure needed someone who had intimate knowledge of the gastrointestinal tract, and so could navigate the equipment through to the intestines — hence my involvement.
After food passes through the stomach, it moves into the first segment of the small intestine — the duodenum — to begin being absorbed into the blood and then the body’s cells.
The lining of duodenum is packed with hormone-producing cells which detect the presence of glucose in food and instantly send signals to the pancreas to release more insulin.
Insulin is a hormone that keeps a tight control of glucose levels in the blood.
If there is too much glucose, the pancreas releases more insulin. If there is too little, the pancreas temporarily shuts off the insulin supply — this helps keep levels in the blood within a normal range.
In diabetes this control system stops working, leading to excess blood glucose.
This gradually disrupts blood supply, including to the lower limbs and — in severe cases —leads to amputation.
A Western-style diet high in sugar and fat can, over several years, damage the duodenum and hinder the action of the hormone-signalling cells that control insulin release.
This new technique aims to reverse that damage by destroying the damaged cells, kick-starting the body’s repair mechanisms so healthy new ones are formed.
The entire procedure takes about an hour and patients are sedated. They can go home the same day, although in the trial we have been keeping them in overnight to keep a closer eye on them.
I start by inserting a thin tube through the mouth and down to the duodenum, carefully injecting a salt water solution into the tiny gap between the top layer of cells and the other layers.
This temporarily ‘lifts’ the top layer, reducing the risk of damage to the delicate deeper layers.
I use X-rays to see precisely where I am. Another tube with a 3cm-long deflated balloon on the end is then inserted and positioned on the damaged cells that need removing.
Pressing a button on a device that’s connected to this tube pumps near-boiling into the balloon to inflate it.
The heat from the water causes an injury that instantly ‘ablates’, or destroys, the cells on the lining of the duodenum.
The device is programmed to know when to stop pumping hot water — it then cools the tissue with cold water to avoid excess damage. The water is drained and the tubes and balloon are removed.
Patients best suited to this treatment are those, like Russell, who have had type 2 diabetes for less than ten years.
Damage after this length of time is likely to be too extensive to reverse. I have treated four patients so far who have all responded very well with no side-effects.
This is a tremendously promising treatment and a randomised trial later this year will give us more data. My advice would be to watch this space.
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Twitter1 comment
This sounds good, an alternative thinking approach.
On radio 4 heard about another development. Genetic research at Exeter Uni. (Hospital ?) seems to have identified by DNA testing a "switch" for releasing insulin after eating that could be heretical being set to 'off', so-to-speak at birth. Perhaps means that loads and loads of babies, youngsters and other people who take insulin could take pills instead.
(Probably Type 1's, then go up ancestry tree and across and down again to identify others with DNA testing. Might also apply to Type two's ?)
Any news ?
DougieP.
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