Obesity is rapidly becoming one of the foremost contemporary health concerns in the UK. In the 80s only 6% of men and 8% of women were obese, and now that number has risen to 29% of adults. One of the biggest risks of obesity is Type 2 Diabetes, and considering the number of people with diabetes has doubled in the last 20 years, it’s clear that obesity is posing a serious threat to the health of the nation.
Type 2 diabetes is the most common form of diabetes, affecting 90% of all sufferers. In this form, the body’s ability to regulate blood glucose is impaired by insulin resistance. This means that, at least initially, cells no longer respond to insulin, which is the hormone that stimulates the absorption of glucose from the blood. With time the body stops producing insulin all together.
The precise mechanism that leads to insulin resistance is still unknown. Numerous studies have researched the topic, with some suggesting that waist width plays a role as the belly fat may produce hormones that decrease insulin sensitivity, while others have suggested that free fatty acids will adjust the threshold at which the insulin response is produced. The uncertainty around how it arises only makes it more difficult to treat.
Why is it so dangerous?
The reason that diabetes is such a threat is its propensity for complications. Chronic elevation of blood glucose will lead to angiopathy, whereby the glucose intake leads to capillaries thickening and weakening. The impact of this is widespread, because as these vessels get weaker they damage all the organs they’re present in. Eventually this can lead to liver failure, swelling and blindness in the eye, dementia or heart failure to name a few. And you’d be wrong to think that these complications are anything short of commonplace, because every week diabetes leads to 160 amputations, 680 strokes and 2000 cases of heart failure.
How do we treat it?
Despite the significant risks that diabetes poses, we’ve yet to discover a cure. And while, in theory, diabetes can be prevented and managed by diet and physical activity, statistics make it clear that it isn’t that easy. In an effort to come up with a treatment scientists have come up with ideas that are somewhat offbeat to say the least.
How does boiling water fit into this? Well, a bizarre treatment has suggested that by burning part of the intestine with hot water some of the hormonal responses can be restored. And while the concept is certainly unconventional there are promising results to back it up.
The treatment is known as the Revita procedure, and it allows patients to regain some insulin sensitivity by killing cells in the duodenum, the first part of the small intestine. This is done using a balloon catheter, which inflates when it reaches the duodenum and releases the water into surrounding tissue. This kills the mucosal layer of the duodenum and allows the duodenum to consequently be “resurfaced”.
This process was inspired by gastric bypass surgeries – when the duodenum was no longer used as a surface for nutrient absorption patients experienced weight loss and greater control of blood sugar. However, bypassing the duodenum did not improve regulation in all patients, only those who had diabetes. This has led to many drawing the conclusion that, in the diabetic, within the duodenum lies some kind of “abnormality” which prevents blood sugar regulation.
One theory that explains this is “anti-incretin” theory. Incretins are hormones that stimulate the production of insulin when nutrients are absorbed. Some speculate that in order to prevent the blood sugar from falling too low the body employs a counter-regulatory mechanism which decreases the effect of insulin. In those who are diabetic the duodenum is unable to regulate the anti-incretin mechanism, resulting in insulin resistance. These abnormalities have been linked with thickening of the membrane, so by killing the cells we are effectively “resetting” the hormonal signalling.
Whatever the reason behind it, it’s becoming clear that the Revita process works. After testing it on 36 patients, the mean decrease in HbA1c was around 0.9%. HbA1c is glycated haemoglobin, and is produced when haemoglobin binds with glucose in the blood. Because red blood cells can survive for 8-12 weeks, and because the binding of glucose and haemoglobin is proportional to the blood sugar concentration, we can use HbA1c as an indicator of average blood sugar over a longer period. A decrease of 1% translates to roughly 25% less chance of complications, so clearly Revita is having an impact.
Revita isn’t flawless, though, and it’s certainly not ready to be offered as a treatment. Monitoring patients has suggested that with unhealthy habits the duodenum will thicken again after the procedure, as the HbA1c markers were lower after 3 months than after 6 months. It takes around 2 years to return to the original state, and while we can then repeat the procedure the jury is out on the long term effects of the treatment. Another point is that this treatment is only really effective for patients that are in early stages, where they’re still producing insulin.
Nevertheless, Revita has huge potential, and has shown that if we want to consider how to treat diabetes, we must first consider how diabetes works. Perhaps diabetes isn’t a chronic condition, but rather a wholly treatable disease.
- “Obesity and Overweight,” British Nutrition Foundation, July 2009
- Rob. S. Beanlands, “Significance of Endothelial and Microvessel Dysfunction”, Clinical Nuclear Cardiology, 2010
- Francesco Rubino, “Diabetes may be a disorder of the upper intestine”, Weill Cornell Medical Centre, March 6, 2008
- Timothy Garvey, “Ablation of the Duodenal Mucosa as a Strategy for Glycemic Control in Type 2 Diabetes: Role of Nutrient Signaling or Simple Weight Loss”, Diabetes Care, December 2016