S2226 Duodenal Mucosal Resurfacing (DMR) for Glycemic Control in Type 2 Diabetes: A Meta-Analysis

Introduction: Prolonged exposure to obesogenic diets leads to functional alterations in the duodenal mucosa causing intestinal malabsorption, insulin resistance and subsequent type 2 diabetes mellitus (T2DM). Duodenal mucosal resection (DMR) is a novel, minimally invasive endoscopic procedure that thermally ablates duodenal mucosa, thereby limiting nutrient-mucosa signaling and exerting metabolic benefits. This meta-analysis evaluates the effectiveness of DMR on glycemic and hepatic parameters in patients with T2DM. Methods: We used the PubMed, Scopus, Web of Science, and Clinicaltrials.gov databases to identify studies, from inception to present. We included original studies that evaluated REVITA DMR procedure (Fractyl Laboratories, Lexington, MA, United States) amongst patients from age 28-75 years, with BMI >25, HbA1c >7.5, and on at least one oral antidiabetic agent. The primary outcomes were changes in metabolic parameters; HbA1c, weight, and homeostatic model assessment of insulin resistance (HOMA-IR), measured at 3-, 6-, and 12-months post-procedure. Results: Among 130 titles identified, 23 were full text reviewed, and 5 studies fulfilling the criteria were screened for final analysis. All 5 studies reported changes in HbA1C, whereas 3 reported weight changes and HOMA-IR. DMR significantly reduced HbA1c at 6 months (−1.21% [95% CI: −1.58 to −0.84]) and 12 months (−0.74% [−0.96 to −0.52]). HOMA-IR also decreased significantly at 6 months (−1.55 [−2.36 to −0.73]), with sustained reductions at 12 months. Weight change was not statistically significant, with a pooled mean difference of −1.60 kg [−4.63 to 1.43] at 6 months and −1.86 kg [−4.99 to 1.28] at 12 months. These findings suggest DMR improves glycemic control and insulin sensitivity through 12 months, with minimal effect on weight. Conclusion: Current data suggests that DMR emerges as an effective procedure and a promising intervention for glycemic control in T2DM with suboptimal medical therapy. Metabolic effects with drops in HbA1c and weight were seen as early as 3 months with effects sustained up to 12 months. A significant drop of at least 1% in A1c was seen at 6 months. Further mechanistic studies are warranted to assess the long-term safety, metabolic durability, and potential application to DMR.