Obesity is considered one of the major causes of Type 2 diabetes, the most common form of the disease affecting 90 to 95 percent of diabetics. The use of laparoscopic gastric bypass surgery to treat obesity, may be a cure for those who are diabetic as well. According to a study from the University Of Pittsburgh Medical Center (UPMC), the process of Type 2 diabetes was either slowed or stopped for people who had laparoscopic gastric bypass surgery, one of the most common types of weight reduction surgery. The odd thing is that a significant number of type 2 diabetes patients undergoing the procedure started improving right after the surgery, long before any weight loss had occurred.
The five year study involved 1,160 people who had gastric bypass surgery at UPMC. Of that group, researchers were able to follow 190 of the 240 who had diabetes before surgery. Almost one-third of the patients stopped their diabetes medications before leaving the hospital. In the five years after surgery, the study patients had not only lost an average of 100 pounds, or 60 percent of excess body weight, but 83 percent had no signs of Type 2 diabetes. According to the study, those who had diabetes for the shortest period (of less than five years) and had the mildest forms saw the greatest improvements.
Researchers were at a loss as to exactly how the procedure helped to resolve diabetes. This conundrum puzzled Italian surgeon Dr. Francesco Rubino, who is now with the New York-Presbyterian Hospital. Dr. Rubino thought the remission of diabetes could have to do with the small bowel. He began performing bypass surgery on diabetic rats, and found that when he disconnected the top of the small intestine, an area called the duodenum, the diabetes disappeared. When he reversed the operation, the diabetes came back. This provided the first scientific evidence that gastric bypass can improve diabetes independent of weight loss, even in subjects who are not obese. "When we bypass the duodenum and jejunum, we are bypassing what may be the source of the problem," said Dr. Rubino. "It should not surprise anyone that surgically altering the bowel's anatomy affects the mechanisms that regulate blood sugar levels, eventually influencing diabetes."
Dr. Rubino's research has led to the opening of one of the first academic medical programs dedicated to the surgical treatment of type 2 diabetes. Led by Dr. Rubino, the Gastrointestinal Metabolic Surgery section at New York-Presbyterian Hospital/Weill Cornell Medical Center will perform gastrointestinal operations to directly treat diabetes, not just as a by-product of weight-loss surgery. The novel procedure, now known as Rubino's Procedure, reroutes the small intestine, leaving the stomach intact and has been performed on patients in several centers worldwide. Dr. Rubino said, "Indeed, metabolic surgery may help shape the future of diabetes care in the next few years, and is possibly the best promise we have ever had to cure the disease."
Scientists at Swansea University School of Medicine are continuing to investigate the phenomenon. Leading the research at the School of Medicine's Diabetes Research Group is Senior Clinical Lecturer Dr. Jeffrey Stephens. "To go from such a high level of insulin-dependency to not needing insulin in a matter of a few days is a dramatic result, and we need to understand the reasons why this happens," he said.
Dr. Stephens and colleagues are focusing on a protein known as Glucagon Like Peptide 1 (GLP-1), which is produced in the small intestine. "Overweight people who have Type 2 diabetes tend to have lower levels of GLP-1 and we are investigating whether these levels return to normal after bariatric surgery. Basically, we want to know whether reducing the size of the small intestine and stomach restores production of GLP-1, and why this should be the case," said Dr. Stephens.
"Not only will this research improve our understanding of why overweight people develop Type 2 diabetes, it may also lead to an effective, non-surgical treatment for those with the condition," he added.
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