Type 2 diabetes: New treatment eliminates insulin for 86% of patients

Original Article ↗ Hacker News Discussion ↗

A small clinical trial reports that an endoscopic procedure called ReCET, combined with GLP‑1 drugs such as semaglutide, let 86% of participants with type 2 diabetes stop using insulin, prompting cautious optimism about a potential shift in treatment. Commenters note that GLP‑1 receptor agonists already produce major weight loss and diabetes prevention benefits, but raise concerns over long‑term side effects, cost, and the tiny sample size (n=14). The conversation broadens into whether obesity and type 2 diabetes should be managed primarily through medication, lifestyle changes like keto or fasting, or some combination, and how cultural, economic, and medical-system factors shape what is realistically achievable.

Study & Treatment Overview

  • Paper describes ReCET, an endoscopic electroporation procedure that ablates duodenal mucosa, followed by GLP‑1 therapy (e.g., semaglutide).
  • Commenters note GLP‑1 drugs alone can already eliminate insulin in ~40% of type 2 diabetics; adding ReCET reportedly raises this to 86% in the n=14 study.
  • Some emphasize that the HN title omits “type 2” and “n=14,” calling the result promising but very early.

GLP‑1 / Tirzepatide Effects and Side Effects

  • Tirzepatide and related GLP‑1/GIP agonists are praised for large average weight loss (~20% of body weight in cited trial) and major reductions in risk of developing type 2 diabetes.
  • Several users on these drugs report mostly mild, transient GI side effects; others say side effects are exaggerated by social media and can be minimized by dose/schedule tweaks.
  • Debate over heart-rate changes and long‑term safety is present but unresolved; long‑duration (10–20 year) data are noted as lacking.
  • Some argue future dosing regimens and oral formulations will improve tolerability and adherence.

Type 1 vs Type 2 Diabetes

  • Multiple comments stress the article is about type 2 only.
  • Type 1 readers express both hope and frustration; stem‑cell–based beta‑cell replacement trials are discussed as “possibly within ~10 years,” with others warning this timeline has been repeatedly promised.
  • There is disagreement over how close a “cure” for type 1 really is, and the challenges of autoimmunity and immunosuppression.

Lifestyle, Diet, and Fasting vs Drugs

  • Strong thread arguing type 2 diabetes and obesity are often reversible or manageable with low‑carb/keto diets, fasting, and sustained weight loss; several personal remission stories.
  • Others counter that “just eat healthy” is not broadly effective, given environmental, cultural, and psychological drivers of overeating and addiction‑like behavior.
  • Ketosis, high‑fiber plant‑based diets, and fasting‑mimicking regimens are all promoted by different users; there is no consensus on a single “best” approach.

Obesity, Culture, and Personal Responsibility

  • Extended debate over whether obesity and type 2 are primarily:
    • personal responsibility/discipline problems, or
    • consequences of modern food systems, culture, and neurobiology.
  • Some argue GLP‑1s may address a more fundamental brain‑level “propensity to overeat,” while diet/exercise mainly treat symptoms.
  • Others reject this framing, insisting overeating is caused by bad diet and inactivity, not the other way around.

Trial Scale, Durability & Access

  • Several users highlight the tiny sample size (14 participants) and unclear duration of effect after stopping GLP‑1 drugs or reverting to prior lifestyle.
  • One commenter cites data that ~50% of people regain weight after stopping GLP‑1s, ~50% maintain or continue losing, suggesting behavior still matters.
  • Cost and access issues are raised: GLP‑1s can be $600–$1,000/month in the US, and continuous glucose monitors may not be covered for type 2 in some systems.