Diabetes – Under the Scalpel

Recent estimates by the International Diabetes Federation and World Health Organization suggest that currently there are 415 people around the world with the disease. This may climb to 650 million by 2040.

Adapted from Francesco Rubino, King’s College London; Scientific American, July 2017

Until now, treatment has primarily been diet, oral medications and insulin injections. Clinical trials involving hundreds of people and multiple research centers have now explored surgery initially developed for weight loss as a treatment for Type 2 diabetes. Reducing the surface of the gastrointestinal tract has a very powerful effect on diabetes. The blood sugar levels return to normal within weeks of surgery, long before weight loss and reduction in fat levels. 50 percent of patients are free of the disease after surgery and most remaining have significant improvement in their blood sugar. The results are so astounding that 45 medical societies have endorsed GI bypass surgery as a standard option for the treatment of Type 2 diabetes. In another study conducted by the author with others at the University of Rome, more than 80 percent of patients were in complete remission for the disease or were maintain good control of their blood sugar levels. A study done at the Cleveland Clinic showed that 89 percent of patients that had the duodenal-jejunal bypass, were not taking insulin five years’ post-surgery.

The Role of the Gut

The GI tract exerts its influence on glucose through hormones, bile acids, glucose transport, intestinal microbes and neural circuits. The lining of the GI tract has special cells that respond to food nutrients by releasing hormones into the bloodstream when stimulated. These hormones can trigger activity in the liver, pancreas and other organs that affects blood sugar levels. Gastric bypass shortens the intestines, thus changing the quantity of released hormones. A study done at the University of Washington showed that gastric bypass operations suppress circulating levels of ghrelin, a hunger-inducing hormone that appears to regulate how certain cells take up glucose. Another study from Dublin showed that GI bypass boosted levels of incretins that increased insulin production.

Bile acids play a role in digesting food, enter the blood the bloodstream and signal cell receptors to increase their uptake of lipids and glucose. GI bypass increases circulating bile acid kevels which in turn increases glucose uptake from the blood. During digestion, glucose moves through the intestinal walls with the help of glucose transport molecules. This process relies on sodium to work properly. After GI bypass surgery, the primary source of sodium, bile, is rerouted away. This hinders the transport mechanism, thus lowering diabetic glucose spikes after a meal. Microbes in the gut also play a key role. Certain species produce chemicals that reduce inflammation and insulin resistance. GI surgery alters the acidity of the gut and changes its microflora. A study done at the Harvard Medical school showed that post GI bypass surgery, the metabolic rate increased with better glucose control. Finally, gut surgery has an effect on neural circuits that influence metabolism. The vagus nerve sends signals between the intestines and the brain, when nutrients pass through the intestines. The signals suppress glucose production in the liver thus lowering overall blood glucose levels.

Devices have been fabricated that uses the same principle as gut bypass surgery. The idea is to cover up the duodenum. Flexible plastic devices are inserted non-surgically through the throat that shield the duodenum. This is in use in Europe and South America. A newer approach, now in clinical trial, is to insert a balloon-tipped device down the throat into the duodenum. The balloon is then filled with hot water that burn away the cells that would react to glucose rich nutrients.

These surgical successes have now paved the way to other novel approaches to treating diabetes that will hopefully be an alternative to insulin injections.

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Diabetes – Under the Scalpel

Recent estimates by the International Diabetes Federation and World Health Organization suggest that currently there are 415 people around the world with the disease. This may climb to 650 million by 2040.

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