Type 2 diabetes
Conditions
Interventions
ReCET or sham procedure in combination with GLP1-RA (semaglutide)
Sponsors
Amsterdam UMC
Eligibility
Age
18 Years to 99 Years
Inclusion criteria
Inclusion criteria: 1. Diagnosed with type 2 diabetes mellitus 2. 28 -75 years of age 3. On daily long acting insulin dose = 24 and = 0.2 nmol/L (0.6 ng/ml) 7. Willing to comply with study requirements and able to understand and comply with signed informed consent
Exclusion criteria
Exclusion criteria: 1. Diagnosed with Type 1 Diabetes or with a history of ketoacidosis 2. Current use of multiple daily doses insulin or insulin pump. 3. Current use of a GLP-1 analogue. 4. Known autoimmune disease, as evidenced by a positive Anti-GAD test, including Celiac disease, or pre-existing symptoms of systemic lupus erythematosus, scleroderma or other autoimmune connective tissue disorder 5. Previous GI surgery that could affect the ability to treat the duodenum such as subjects who have had a Bilroth 2, Roux-en-Y gastric bypass, or other similar procedures or conditions 6. History of chronic or acute pancreatitis 7. Known active hepatitis or active liver disease 8. Symptomatic gallstones or kidney stones, acute cholecystitis or history of duodenal inflammatory diseases including Crohn*s Disease and Celiac Disease 9. History of coagulopathy, upper gastro-intestinal bleeding conditions such as ulcers, gastric varices, strictures, congenital or acquired intestinal telangiectasia 10. Use of anticoagulation therapy (such as phenprocoumon and acenocoumarol) which cannot be discontinued for 3-5 days before and 48 hours after the procedure and novel oral anticoagulants (such as rivaroxaban, apixaban, edoxaban and dabigatran) which cannot be discontinued for 48 hours before and 48 hours after the procedure in accordance with the local protocol 11. Use of P2Y12 inhibitors (clopidogrel, pasugrel, ticagrelor) which cannot be discontinued for 5 days before and 48 hours after the procedure in accordance with the local protocol. Use of aspirin is allowed. 12. Unable to discontinue NSAIDs (non-steroidal anti-inflammatory drugs) during treatment through 4 weeks post procedure phase 13. Taking corticosteroids or drugs known to affect GI motility (e.g. Metoclopramide) 14. Receiving weight loss medications such as Meridia, Xenical, or over the counter weight loss medications 15. Anemia, defined as Hgb < 6.2 mmol/l 16. Known history of severe permanent cardiac arrhythmia*s with clinical symptoms 17. Significant cardiovascular disease, including known history of valvular disease or myocardial infarction, heart failure, transient ischemic attack, or stroke within 6 months prior to the screening visit 18. With any implanted electronic devices or duodenal metallic implants 19. eGFR or MDRD < 30 ml/min/1.73m^2 20. Active systemic infection 21. Active malignancy within the last 5 years 22. Not potential candidates for surgery or general anesthesia 23. Active illicit substance abuse or alcoholism 24. Pregnancy or wish getting pregnant in next year 25. Participating in another ongoing clinical trial of an investigational drug or device that can interfere with the current study 26. Any other mental or physical condition which, in the opinion of the investigator, makes the subject a poor candidate for clinical trial participation
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| • Safety: Incidence rate of adverse events. • Feasibility: Procedure time and technical success rate • Primary efficacy: Protocol driven free of insulin at 6 months and HbA1c | — |
Secondary
| Measure | Time frame |
|---|---|
| • Secondary efficacy: - Time in range (flash glucose monitoring), - liver fat fraction (MRI-PDFF) and fibrosis - sympathovagal activity (Nexfin device). - bloodL HbA1c, HOMA-IR, Fasting Plasma Glucose - Weight, BMI, waist circumference - lipid panel, liverenzymes etc. - micro albumin - glucoregulatory hormones (Mixed Meal Test) - Microbiota diversity oral and fecal - Intake registration In the active group, compared to the control group at 6 months | — |
Countries
Netherlands
Contacts
Public ContactJJGHM Bergman
Amsterdam UMC
Outcome results
None listed