16 March 2023

Words by Robyn Riley, Herald Sun

More than one million Australians living with Type 2 diabetes rely on daily insulin jabs to manage their condition – but that may soon be a thing of the past.

Melbourne’s Austin and St Vincent’s Hospitals are leading a world-first trial that, if successful, could see a reduction of insulin injections to treat advanced type 2 diabetes.

Under investigation is a new endoscopic procedure called ReCET that uses a gentle electrical pulse to see if it can regenerate cells in the duodenum (the first part of the small intestine) to help regulate blood sugar.

It follows promising results from a first phase study – called the Regent-1 Study – with Melbourne and Sydney investigators now reviewing its potential as a therapy for the reduction, or even possible elimination, of insulin.

Clinical scientist and endocrinologist Professor Elif Ekinci describes the procedure as one of the most exciting projects she has been involved in.

Professor Ekinci is co-investigator for the new trial and heads Diabetes Austin Health and the Australian Centre for Accelerating Diabetes Innovations (ACADI) at the University of Melbourne.

There are around one million Australians with type 2 diabetes, a condition where the body either doesn’t produce insulin, or resists it. When treatments such as lifestyle including changes to diet and exercise do not work and first-line medications such as Metformin, and other drugs added to help manage type 2 diabetes are not working, insulin delivered by debilitating daily injections is often a last resort.

But insulin therapy also has health risks including weight gain and hypoglycaemia, which is low blood glucose levels.

Professor Ekinci’s team will join with St Vincent’s Hospital in Melbourne and BMI Clinics in Sydney to run the trial. She says it offers hope.

“It would break my heart seeing patients with type 2 diabetes on the hospital wards end up with limb loss or recent heart attack or a stroke,” Professor Ekinci said. “I have seen people go on to dialysis; people losing their vision. Diabetes is a huge issue in our society and to our health system.”

Professor Ekinci says this treatment could be a new way of treating diabetes.

She says research shows that cells in the lining of the small intestine play an important role in controlling blood sugar levels, but that in people with type 2 diabetes these cells may not function properly.

“The duodenum is really an important part of the body as it prepares the body for nutrient intake,” Professor Ekinci says. “When the duodenum is not functioning, it can be associated with the development of diabetes.”

Professor David O’Neal from St Vincent’s Hospital is also a co-investigator and says the team has a new understanding of the role of special ‘signalling’ cells in the duodenum which are believed to be responsible for helping to control blood sugar levels.

“By regenerating the lining in the duodenum, we’re pressing a ‘re-set’ button in the small bowel which we believe to be dysfunctional in people living with type 2 diabetes, essentially restoring that dysfunction and reinstating healthier, functioning signalling cells which allow the body to control sugar circulating in the blood.”

Gastroenterologist and lead clinical investigator Dr Adrian Sartoretto said the trial is opening the door for a potential insulin treatment reversal that could transform patients’ lives.

“The procedure doesn’t require surgery, it is similar to a gastroscopy, and is done under general anaesthetic, and lasts about 60 minutes,” he said.

Professor Ekinci says for the first time the study will look at this endoscopic approach for patients.

“It is exciting because if the trial results are positive, it offers an alternative,” she says.

The team is now recruiting 60 Australians with type 2 diabetes including those who can only manage their diabetes through daily insulin injections.

“Once we formally evaluate the effectiveness of the procedure, we’ll certainly be looking at its potential to become an approved therapy for all people with type 2 diabetes down the track,” she said.

To register for the trial visit www.regent1study.com.au