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Return to Is Type 2 Diabetes an Operable Intestinal Disease? Overview

More on Is Type 2 Diabetes an Operable Intestinal Disease?

Is Type 2 Diabetes an Operable Intestinal Disease?

New York (Mar 23, 2010)

Operating room with digital display highlighted

Physicians and scientists at NewYork-Presbyterian have pioneered the idea and practice of "metabolic surgery," a groundbreaking approach aimed at specifically treating type 2 diabetes. In addition to providing a therapeutic option of potential curative intent, this approach introduces a revolutionary way of thinking about diabetes as an intestinal disorder potentially amenable to surgical treatment.

There is a growing body of evidence that conventional metabolic weight-loss surgery like Roux-en-Y Gastric Bypass (RYGB) and biliopancreatic diversion (BPD) dramatically improved diabetes, often resulting in normalization of blood glucose levels. In fact, research has confirmed that 83% of patients experience a complete remission of type 2 diabetes after gastric bypass surgery. What is striking is that in a third of cases, return to euglycemia and normal insulin levels occurs within days to weeks of the surgery.

Dr. Francesco Rubino
Dr. Francesco Rubino

Dr. Francesco Rubino, Chief of Gastrointestinal Metabolic Surgery at NewYork-Presbyterian/Weill Cornell Medical Center demonstrated that gastric bypass surgery can improve diabetes through direct anti-diabetic mechanisms and that decreased caloric intake and weight loss alone cannot entirely explain why surgery improves diabetes. "These findings – according to Dr Rubino – suggest that gastrointestinal bypass operations may tackle dysfunctional intestinal mechanisms responsible for abnormalities of glucose homeostasis."

Dr. Judith Korner
Dr. Judith Korner

Researchers at NewYork-Presbyterian Hospital are working to understand the reasons behind this unexplained benefit. Judith Korner, M.D., Ph.D., Director of the Weight Control Center at NewYork-Presbyterian/Columbia University Medical Center explains, "We know that the gut is a major player in diabetes resolution and that there are pathways of communication between insulin producing beta cells in the pancreas, the appetite centers in the brain and adipose tissue. We think delivery of nutrients to the distal gut may help to stimulate hormones such as GLP-1 that act on beta cells and regulate blood glucose. We are not sure whether the resolution of diabetes is caused by bypassing the foregut or rapid delivery of nutrients to the distal gut, or both."

Video with Dr. Rubino
Video: Dr. Rubino talks about
metabolic surgery.
(watch video)

Dr Rubino's studies have shown that preventing duodenal passage of nutrients by gastrointestinal bypass operations improves glucose tolerance only in diabetic patients and is detrimental in normal subjects. These findings are consistent with the possibility that the surgical bypass of the proximal small intestine reverses an intestinal mechanism characteristic of diabetic patients, but not found in normal individuals. Dr. Rubino theorizes, "Type 2 diabetes might be characterized by a component of duodenal-jejunal dysfunction and when we bypass the upper small intestine, we are bypassing what may be the source of the problem." He adds, "Further evidence exists from both animal studies and clinical research that gastrointestinal bypass procedures do not cause significant body weight loss when performed in subjects with normal body weight and Body Mass Index (BMI)." Doctors at NewYork-Presbyterian believe this growing evidence supports the position that Body Mass Index (BMI) greater than 35 can no longer be used as a cutoff to determine who is an ideal candidate for surgical treatment of diabetes.

Studies are underway at NewYork-Presbyterian to explore surgically treating type 2 diabetes in people who are just moderately obese and comparing surgical results with individuals treated with intensive life-style and medical management. Results of these studies may expand the current BMI criteria used to determine eligibility for bypass surgery to treat diabetes.

"By answering the question of how diabetes surgery works," says Dr. Rubino, "we may be answering the question of how diabetes itself works."

For More Information

  • Information about the study at NewYork-Presbyterian/Columbia is available by calling 212-305-0486.
  • Information about the study at NewYork-Presbyterian/Weill Cornell is available by calling 212-746-5925.

Francesco Rubino, M.D.,is the Chief of Gastrointestinal Metabolic Surgery and an Associate Attending Surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. He is also an Associate Professor of Surgery at Weill Cornell Medical College.

Judith Korner, M.D., Ph.D., is an Assistant Attending Physician at NewYork-Presbyterian Hospital/Columbia University Medical Center and the Florence Irving Assistant Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons.

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