Mechanisms of action of duodenal mucosal resurfacing in insulin resistant women with polycystic ovary syndrome

BACKGROUND

Duodenal mucosal resurfacing (DMR) is a novel day-case endoscopic intervention which results in weight loss-independent reductions in HbA1c in patient with type 2 diabetes mellitus (T2DM). We hypothesized that DMR works by increasing insulin sensitivity and we aimed to investigate the mechanism of action of DMR through longitudinal metabolic phenotyping in humans.

METHODS

Thirty-two insulin-resistant women with polycystic ovary syndrome (PCOS) and obesity were randomised in a double-blinded manner to DMR or sham endoscopy. They underwent measurements of insulin sensitivity using euglycaemic hyperinsulinaemic clamps, insulin secretion using oral glucose tolerance tests and reproductive function using weekly reproductive hormone profiles and ovarian ultrasonography for 6 months post-intervention.

RESULTS

A small increase in total body insulin sensitivity measured by the clamp was observed in both groups at week 12. An increase in insulin sensitivity, as measured by HOMA-IR, was observed in both groups at week 24. There was an increase in the number of menses (median 2 DMR, 0.5 sham). There were no significant differences between the two groups in these outcomes or insulin secretion.

CONCLUSIONS

These findings suggest that DMR does not work by increasing insulin sensitivity in euglycaemic, insulin resistant women with PCOS. The procedure may exert its effects only in the context of hyperglycaemia or pathologically hyperplastic, insulin-desensitised duodenal mucosa.

[Control of cardiovascular risk factors in type 2 diabetes in a specialized diabetic clinic]

BACKGROUND

Achieving an adequate control of glycaemic and cardiovascular risk factors (CVRFs) is essential in patients with type 2 diabetes mellitus (T2DM). However, several studies have shown that the percentage of patients achieving these goals is scarce. We evaluated the degree of control of CVRFs target goals in T2DM patients who regularly attend a specialized diabetic clinic.

METHODS

We studied T2DM patients who attended the specialized Diabetic Unit at the Department of Endocrinology of Clínica Universitaria de Navarra with a minimum follow-up of one year. Clinical characteristics, chronic complications and treatments were collected and patients were classified into groups according to the fulfilment of target glycated haemoglobin (HbA1c), LDL cholesterol and blood pressure (BP) levels, predefined according to the presence of different comorbidities and the duration of T2DM.

RESULTS

We analysed 137 patients (75% men) with T2DM, with an average age of 67 years and a 12.7 year duration of diabetes. During follow-up, 83.9% of the patients were within the individualized HbA1c target, 76.6% considering BP and 67.2% in terms of LDL-cholesterol. In addition, 68% had concomitantly the three main variables within the target.

CONCLUSIONS

In our population of T2DM, HbA1c, LDL cholesterol and BP targets were achieved in a substantial proportion of patients (67-91%). Perhaps the intense and individualized care offered through a specialized diabetes unit may explain these results.