New research presented at UEG Week 2024 has introduced a strategy that could considerably reduce the need for insulin therapy in patients with type 2 diabetes (T2D).¹
The study investigated a novel approach combining ReCET (Re-Cellularization via Electroporation Therapy) with the GLP-1 RA, semaglutide. Remarkably, 86% of participants enrolled in the study were able to discontinue insulin therapy after undergoing the approach.¹
Performed under deep sedation, ReCET is an innovative endoscopic technique targeting the duodenum, the first part of the small intestine. By delivering nonthermal pulsed electric fields to the duodenal lining, it induces apoptosis in mucosal cells and stimulates the regeneration of healthier, metabolically active cells. This regeneration is believed to reset abnormal duodenal signalling—a suggested contributor to the pathophysiology of T2D—and is also thought to enhance the body’s sensitivity to its own insulin, although the exact mechanism behind this remains unknown.¹,²
In this first-in-human study, 14 participants aged 28 to 75 years, with BMIs between 24 and 40 kg/m², underwent the ReCET procedure. Following this, they adhered to a two-week isocaloric liquid diet before gradually increasing their semaglutide dosage to a maximum of 1 mg per week.¹
At follow-ups conducted at 6, 12 and 24 months post-procedure, 86% of participants no longer required insulin therapy. These individuals maintained stable glycaemic control, with HbA1c levels consistently below 7.5%. Importantly, all participants successfully completed the procedure without any serious adverse effects. The maximum dose of semaglutide was well-tolerated by 93% of participants, with only one experiencing nausea that prevented reaching the highest dose.
“Unlike drug therapies that require daily adherence, ReCET is compliance-free, addressing the critical challenge of long-term treatment adherence in T2D,” explained Dr Celine Busch, lead author of the study. “Additionally, this treatment is disease-modifying—it enhances the patient’s sensitivity to their own endogenous insulin, tackling the root cause of the disease rather than simply controlling it, as most current therapies do”.³
While the results are promising, the researchers plan to validate their findings through larger randomized controlled trials. Dr Busch shared details of their ongoing EMINENT-2 trial, stating, “This trial uses the same inclusion and exclusion criteria and administration of semaglutide, but participants will either undergo a sham procedure or ReCET. The study will also incorporate mechanistic assessments to better understand the underlying effects of ReCET”.³
References:
- Busch, C.B.E, et al. Durable effects of duodenal ablation using electroporation combined with semaglutide to eliminate insulin therapy in patients with type-2 diabetes; the 24-month results. Presented at UEG Week 2024; 14 October 2024; Vienna, Austria.
- Mayo Clinic News. Researchers study novel endoscopic therapy for type 2 diabetes. 2024. [Press release]. Available at: (accessed 12 November 2024)https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/researchers-study-novel-endoscopic-therapy-for-type-2-diabetes/mqc-20563134
- UEG. Novel procedure combined with semaglutide may eliminate insulin dependency in type 2 diabetes. 2024. [Press release]. Available at: https://ueg.eu/a/360 (accessed 12 November 2024)
Disclosure: This article was created by the touchENDOCRINOLOGY team utilizing AI as an editorial tool (ChatGPT (GPT-4o) [Large language model]. https://chat.openai.com/chat.) The content was developed and edited by human editors. No funding was received in the publication of this article.
