Duodenal Mucosal Resurfacing for Type 2 Diabetes

Duodenal mucosal resurfacing (DMR) is a minimally invasive procedure that uses heat to resurface the upper intestine. Like bariatric surgery (weight-loss surgery), it has been shown to help with diabetes, but it’s less risky than bariatric surgery.

Learn more about the pros and cons of this procedure and whether it would be appropriate for you.

What Is Duodenal Mucosal Resurfacing?

DMR is done for people with diabetes to help them better manage the disease. It is a surgery that involves using heat to resurface the upper intestinal lining. The surgery helps regenerate (regrow and replace) the lining of the upper intestine, which improves how nutrients are absorbed from the duodenum, the upper part of the intestine that connects the small intestine to the stomach.

Research has shown that when the duodenum does not function properly, it can lead to insulin resistance, hyperinsulinemia (too much insulin in the blood), and the body’s impaired ability to process, break down, and use glucose properly.

Benefits for Type 2 Diabetes

DMR surgery can improve the body's response to insulin (a hormone created by your pancreas that controls the amount of glucose, or sugar, in your bloodstream) by correcting how the intestines absorb nutrients and other chemicals. According to research, having just one DMR procedure can help people with diabetes replace their insulin therapy with oral medication that improves how the body uses insulin.

While the reason for the improvement isn’t entirely known, it’s thought that DMR helps regulate the body's bile acid response. Bile acid play a role in diabetes because of its ability to stimulate insulin secretion as well as glucagon-like peptide 1, which is an intestinal hormone that helps with blood sugar regulation. By improving bile acid response, changes occur within the body that enhance how insulin is used. This improves how much sugar is converted into energy for cells and how much stays in the blood.  

Procedure

The minimally invasive surgical procedure is done using an endoscope. An endoscope is a long and thin tube with a camera on the end of it. During the procedure, the endoscope is inserted into the body through the mouth to reach the duodenum.

A catheter with a heated balloon attached to the end is inserted through the mouth and down to the top of the small intestine. The heat from the balloon on the catheter changes cells in the duodenum so that they are better able to absorb glucose and release the hormones needed to control blood sugar levels.

Side Effects

While DMRs are considered both safe and effective, they may cause some side effects. Some mild and common side effects are:  

• Abdominal pain
• Diarrhea
• Hyperglycemia (high blood sugar)
• Hypoglycemia (low blood sugar
• Headache
• Throat infection
• Constipation
• B12 deficiency
• Malaise (general feeling of being unwell)

Extremely rare adverse events have also occurred following a DMR procedure, including:

• Perforation (a hole) of the middle of the small intestine
• Rectal bleeding

Outlook

According to research, the outlook following a DMR for people with diabetes is good. One double-blind study (a study in which neither the researchers or subjects know if they are being given the therapy being studied or a placebo) examined the effectiveness of the procedure 24 weeks after it was performed. It found that every person who underwent a DMR was able to manage their diabetes effectively with medication. It also improved insulin resistance.

Risks

The risks of a DMR are minimal, and the procedure is considered highly safe and effective. However, all surgical procedures may come with some risks. For example, severe adverse events have been documented, such as perforation and rectal bleeding. As with any type of upper GI endoscopy procedure, risks other than the ones mentioned above may occur, such as bleeding or infection.

Some complications may also occur because of general anesthetic, including:

• A severe allergic reaction (anaphylaxis)
• Waking up during the procedure

Other Treatment Options

Bariatric surgery is another treatment option used to help treat diabetes. It is typically reserved for people with diabetes who also have obesity. It helps with weight loss, and people with obesity may be able to manage their disease better if they are at a lower weight.

While the surgery has been shown to improve blood sugar control in many people, it is far more invasive than a DMR and comes with more risks, such as:

• Dumping syndrome, which is a condition that causes food to move into the bowel too fast after you eat, leading to diarrhea and hypoglycemia
• Regaining the weight back
• Gallstones
• Vomiting
• Pain
• Acid reflux
• Difficulties swallowing food
• Surgical complications such as hemorrhage (excessive bleeding in a short time), infection, and ulcers in the intestines 

Summary

DMRs are minimally invasive surgical procedures that can help people with diabetes control their blood sugar levels. DMR works by restoring the action of bile acid and the duodenum, improving the body’s ability to absorb nutrients and chemicals that help better manage diabetes. As with any surgery, there are some side effects and risks associated with DMRs.

A Word From Verywell

You can be doing all the right things and still have trouble with your blood sugar levels. Diabetes is complex, and even the right actions are not always enough. The good news is that more options for treating type 2 diabetes, such as DMRs, are emerging. While a surgical procedure is never exciting, it can give you hope for better disease management now and in the future.