1 Recommendations

1 Recommendations


More research is needed on endoscopic duodenal mucosal resurfacing for insulin resistance in type 2 diabetes.


This procedure should only be done as part of a formal research study, and a research ethics committee needs to have approved its use.

More research


More research, which should ideally be adequately powered randomised controlled trials, analysis of registry data or other suitably designed studies, is needed on:

  • patient selection

  • procedure used

  • quality of life

  • blood sugar control

  • change in antidiabetic medication (including insulin)

  • complications

  • long-term outcomes.

Why the committee made these recommendations

The evidence on the efficacy and safety of this procedure is limited, and comes mainly from 1 randomised controlled trial with a follow up of only 24 weeks. This trial found that, compared with a sham procedure, duodenal mucosal resurfacing statistically significantly (that is, the results are reliable and unlikely to be due to chance) reduced HbA1c (a measure of average blood sugar level) in the European subgroup, but not in the whole trial group or the Brazilian subgroup. Overall, there are uncertainties about the safety and long-term outcomes of the procedure. So, this procedure should only be used in research.

  • National Institute for Health and Care Excellence (NICE)