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Reduction of HbA1c in patients with type 2 diabetes following duodenal mucosal resurfacing: could other factors be at play?
  1. Michael P Johnston1,
  2. Ryan Malcolm Buchanan1,2,
  3. Janisha Patel1,
  4. Nadeem Tehami1
  1. 1 Department of Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton, Southampton, UK
  2. 2 Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK
  1. Correspondence to Dr Michael P Johnston, Hepatology, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK; michael.johnston1{at}

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We were interested to read the recent article by van Baar and colleagues that described an open-label phase II trial of endoscopic duodenal mucosal resurfacing (DMR) in the management of patients with type 2 diabetes mellitus (T2DM).1 van Baar and colleagues demonstrated improvements in a number of parameters, most impressive of which was the reduction in haemoglobin A1c (HbA1c) at 12 months. It is intriguing to consider what the underlying mechanisms might be for this observed improvement in glycaemic control in patients with T2DM, what confounders might be at play and how these might inform the design of future sham-controlled studies.

For example, the investigators comment that the initial weight loss ~2.3 kg observed in …

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  • Contributors All four authors reviewed the manuscript and prepared the letter for submission. MPJ: led the preparation of the final draft, which was reviewed by RMB, JP and NT before submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.