Duodenal Mucosal Ablation Promising for Blood Sugar Control in Type 2 Diabetes: Study Finds

UK: A new meta-analysis published in BMJ Frontline Gastroenterology highlights the potential of duodenal mucosal ablation (DMA) as a novel endoscopic approach for improving blood sugar control in people with inadequately managed type 2 diabetes mellitus (T2DM). The research, led by Benjamin Charles Norton and colleagues from University College London, systematically assessed the efficacy and safety of DMA across currently available technologies, providing important insights into its clinical role. DMA is designed to selectively target and ablate the thickened duodenal lining, which is thought to play a role in impaired glucose metabolism. By reshaping the mucosa, the therapy aims to restore better metabolic control, particularly in patients whose diabetes remains uncontrolled despite standard treatment. The team conducted a comprehensive search of Medline, Cochrane, and Scopus databases to identify studies reporting outcomes on DMA up to June 2024. Eight studies, comprising 341 patients, were included in the pooled analysis. These investigations covered both thermal ablation techniques (such as REVITA and RFVA) and non-thermal modalities (such as ReCET). The study revealed the following notable findings: HbA1c levels dropped by an average of 1.13% at six months following duodenal mucosal ablation (DMA). This improvement was consistent across different technologies, though variability between studies was observed. Factors such as patient lifestyle and treatment adherence may have contributed to the observed heterogeneity. Serious adverse events (SAEs) were infrequent, ranging between 0% and 14.3% in individual studies. The pooled estimate showed a low overall SAE rate of just 2%, highlighting the favourable safety profile of DMA. The authors emphasised that while DMA shows encouraging results, its full potential could be realised by refining procedural aspects, such as extending the ablation length, alongside optimising patient-level factors. This dual approach could help reduce variability in outcomes and maximise therapeutic benefit. “DMA appears to offer a reliable reduction in HbA1c for patients struggling with glycaemic control, and importantly, it does so with a relatively low risk of serious complications,” the researchers wrote. The findings support DMA as an emerging adjunctive therapy for type 2 diabetes, particularly for individuals who do not achieve sufficient control with conventional measures. However, the study also calls for further long-term research to clarify the durability of response, refine procedural techniques, and better understand how patient characteristics influence outcomes. "The analysis provides compelling evidence that duodenal mucosal ablation can deliver meaningful improvements in blood glucose management with an acceptable safety profile, positioning it as a promising tool in the expanding therapeutic landscape for type 2 diabetes," the authors concluded. Reference: Norton BC, Papaefthymiou A, Telese A, et alPerformance and safety of duodenal mucosal ablation in the management of type 2 diabetes: a systematic review and meta-analysisFrontline Gastroenterology Published Online First: 24 August 2025. doi: 10.1136/flgastro-2025-103211