Eliminating exogenous insulin therapy in patients with type 2 diabetes by duodenal ablation and GLP-1RA decreases risk scores for cardiovascular events

• Published in: Cardiovascular diabetology 2022-09, Vol.21 (1), p.191-8, Article 191
• Main Authors: Meiring, S, Busch, C B E, van Baar, A C G, Hemke, R, Holleman, F, Nieuwdorp, M, Bergman, J J G H M
• Format: Article
• Language: English
• Subjects: Abdomen; Adipose tissue; Arteriosclerosis; Blood glucose; Blood pressure; Body fat; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - diagnostic imaging; Cardiovascular Diseases - etiology; Cholesterol; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Diabetes type 2; DMR; Duodenal ablation; Endoscopy; GLP-1 and duodenum; GLP-1 receptor agonists; Glucagon; Glucagon-Like Peptide-1 Receptor - agonists; Humans; Hyperinsulinemia; Hyperinsulinism - chemically induced; Hyperinsulinism - complications; Hypoglycemic Agents - adverse effects; Insulin; Insulin - adverse effects; Insulin resistance; Lipids; Low density lipoprotein; Magnetic resonance imaging; Mucosa; Patients; Risk Factors; Triglycerides
• ISSN: 1475-2840; 1475-2840
• DOI: 10.1186/s12933-022-01628-z

Duodenal Mucosal Resurfacing (DMR) is an endoscopic ablation technique aimed at improving glycaemia and metabolic health in patients with type 2 diabetes mellitus (T2DM). DMR has an insulin sensitizing effect in patients with T2DM. Reducing hyperinsulinemia can improve cardiovascular health. In the INSPIRE trial, we combined a single DMR with a glucagon-like-peptide-1 receptor agonist (GLP-1RA) and demonstrated elimination of insulin treatment in 69% of patients at 6 months and 53% of patients at 18 months while improving glycaemic control and metabolic health. We hypothesized that this treatment approach is associated with improved cardiovascular health, by reducing hyperinsulinemia. Before and 6 months after starting the combination treatment to replace insulin, the following assessments were performed to evaluate cardiovascular health: magnetic resonance imaging (MRI) to measure abdominal visceral adipose tissue volume, ambulatory 24 h blood pressure (ABPM) analysis, postprandial insulin and triglycerides, fasting lipid panel and urine microalbumin. The Atherosclerotic Cardiovascular Disease (ASCVD) score was calculated to estimate 10-year risk of cardiovascular disease or stroke and the diabetes lifetime-perspective prediction (DIAL) score was calculated to estimate years free of cardiovascular disease. Six months after replacing exogenous insulin by DMR and GLP-1RA, visceral adipose tissue decreased significantly by 24%. Postprandial triglyceride and insulin concentrations decreased significantly (p