Type 2 diabetes is a chronic, progressive metabolic condition characterised by insulin resistance and insufficient pancreatic insulin production, resulting in hyperglycaemia. The condition is commonly associated with obesity, physical inactivity, raised blood pressure, periodontitis, disturbed blood lipid levels and a tendency to develop thrombosis. It is recognised to lead to an increased cardiovascular and stroke risk.
Dietary control is the mainstay of type 2 diabetes treatment. Weight loss and being active are also recommended to help manage the condition. In addition to lifestyle modification, type 2 diabetes is controlled using metformin, insulin or other medicines, with the aim of keeping a person's blood sugar levels within a healthy range. These treatments have varying efficacy and can sometimes cause side effects, including hypoglycaemia. NICE's guideline on type 2 diabetes in adults describes its management.
Endoscopic duodenal mucosal resurfacing is a minimally invasive procedure. It involves endoscopic exploration under general anaesthesia or deep sedation. This is followed by submucosal expansion with saline, and then hydrothermal ablation of the duodenal mucosa under direct vision with fluoroscopic guidance. The aim is for mucosal regeneration, and so to treat the duodenal dysfunction that is thought to contribute to insulin resistance.