A new study shows that faecal transplantation from healthy donors can help people with type 1 diabetes who have severe gut disorders. “I have consulted these people for 30 years, and this is the first time that a new type of treatment has had such potential,” says a researcher.
Up to one quarter of people with type 1 diabetes have diabetic gastroenteropathy, an often debilitating disease with long-lasting symptoms of nausea, vomiting, bloating and diarrhoea.
Few effective treatments are available, but a new study shows that faecal transplantation with encapsulated faeces from healthy donors may be effective since it considerably improved both symptoms and the quality of life.
According to a researcher behind the study, the results may represent the beginning of a new approach for treating people with diabetic gastroenteropathy.
“These remarkable results were both statistically significant and clinically relevant. We are now investigating how to establish a larger study that can confirm these promising results and can determine how to use this treatment optimally,” explains Klaus Krogh, Clinical Professor and Consultant, Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus University and Steno Diabetes Center Aarhus.
The research has been published in eClinicalMedicine.
The study was carried out in collaboration between researchers from Aarhus University Hospital (Department of Hepatology and Gastroenterology; Department of Clinical Immunology – Blood Bank and the Centre for Faecal Microbiota Transplantation, Department of Hepatology and Gastroenterology), Aarhus University, Aalborg University Hospital, Aalborg University, Steno Diabetes Center Aarhus, Steno Diabetes Center Odense, Steno Diabetes Center Nordjylland, Odense University Hospital and the DTU National Food Institute at the Technical University of Denmark, Kongens Lyngby.
Nerve damage results in major gut problems
When people develop diabetic gastroenteropathy, it starts with elevated blood glucose. Diabetic gastroenteropathy is most common in type 1 diabetes but affects people with type 2 diabetes.
Elevated blood glucose damages nerve cells, including those in the gut. Damage to gastrointestinal nerve cells disturbs how the gut functions, from the stomach to the rectum.
Peristalsis is disturbed, and this can slow passage through the intestines and change the composition of the gut microbes involved in gut health and health in general.
The symptoms of nerve damage in the gut and diabetic gastroenteropathy include bloating, abdominal pain, nausea, constipation, diarrhoea and faecal incontinence.
“Diabetic gastroenteropathy can develop after a few years of elevated blood glucose, but since type 1 diabetes is often diagnosed early in life, I have many patients in their thirties. For them, faecal incontinence greatly reduces their quality of life. It can be profoundly humiliating, and there is little we can do for them,” says Klaus Krogh, who adds that he thinks he has more of these types of patients than any other doctor in Denmark.
Donor faeces may help
The researchers aimed to investigate whether faecal transplantation from a healthy donor could help these people.
Faecal transplantation is a miraculous treatment for people with Clostridium difficile gut infections, but researchers have tried faecal transplantation many times for people with many other diseases without positive results.
“But these people are desperate, so it was worth trying, and antibiotics can help some of these people for a while, which indicated that changing the microbial composition of the gut through faecal transplantation might help,” explains Klaus Krogh.
Faecal transplantation from healthy donors
Twenty people with type 1 diabetes, diabetic gastroenteropathy and severe diarrhoea and bloating participated and received encapsulated faecal transplantation once from a healthy donor or a placebo.
After four weeks, the researchers examined whether the groups differed in symptoms and quality of life.
Then all participants received active faecal transplantation, meaning that half were treated twice and the other half were treated once.
Remarkable results
The faecal transplantation was a resounding success, reducing the participants’ symptom burden from 58 to 35 on the Gastrointestinal Symptom Rating Scale after four weeks.
This included large declines in feelings of bloating, diarrhoea and pain. In the placebo group, the score dropped from 64 to 56.
In addition, the participants improved their quality of life from 108 to 140 on the Irritable Bowel Syndrome Impact Scale. The score in the placebo group increased from 77 to 92.
Finally, the faecal transplantation was associated with only mild side-effects.
Want to determine why transplantation is effective
Following the success of the study, the participants asked to continue faecal transplantation, and the researchers therefore applied for additional funding, so that the participants now receive faecal transplantation every three months.
“We are really pleased with these results. I have been a doctor for 30 years and have seen many such patients, and we tried something completely new that looks like it could really make a difference for these people. Performing research is rewarding because it is relevant to the patients,” notes Klaus Krogh.
Klaus Krogh and colleagues are now applying for funding to establish a larger study to validate that faecal transplantation is more effective more than other types of treatment.
“We also want to determine why faecal transplantation is as effective as it appears to be. We aim to determine the exact mechanism here,” concludes Klaus Krogh.
