Insulin resistance[38] is the pathophysiologic etiology of several metabolic disorders including diabetes and fatty liver disease, and nutrient delivery to jejunum without contact to duodenum demonstrated to increase the insulin sensitivity in human subjects.[39] DMR restores the normal mucosal interface by resurfacing via hydrothermal ablation based on the assumption that the duodenal surface is mediating an abnormal signal damaging the endogenous insulin-sensitive tissues. Here, INS is linked to fatty liver disease.