Gastric Bypass (MGB) Successfully Treats Type II Diabetes

Gastric Bypass (MGB) Successfully Treats Type II Diabetes

Amplify’d from clos.net

Gastric Bypass Surgery Cures
Diabetes

French researchers find
diabetes disease quelled even if patient isn’t obese

 
 

Gastrointestinal surgery as treatment for type 2 diabetes.

Weill Cornell Medical College of Cornell University-New
York Presbyterian Hospital, New York, New York 10065, USA.

PURPOSE OF REVIEW: As the incidence of type 2 diabetes
continues to rise worldwide at epidemic proportions, endeavors to find more
effective therapies increase. Gastrointestinal bypass surgery is now gaining
awareness as a potential effective and long-term treatment.

RECENT FINDINGS: There is now a substantial body of evidence
supporting the efficacy of gastrointestinal surgery in controlling type 2
diabetes. This is well documented in several studies of obese diabetic patients
undergoing gastrointestinal bypass procedures. Additionally, smaller studies and
case reports also demonstrate the efficacy of gastrointestinal bypass surgery in
nonobese diabetic patients. The pathophysiologic basis of the improvement in
diabetes after gastrointestinal bypass surgery is still unclear; however, the
dominant hypotheses involve changes in hormone signaling from the small bowel.

SUMMARY: The implications of ‘diabetes surgery’ are vast,
and could dramatically change the face of diabetes as we know it today. In
clinical practice surgery could represent an alternative for the treatment of
diabetes. On a broader perspective, surgery may facilitate research aimed at
understanding the etiology of the disease.

PMID: 18316951 [PubMed – indexed for MEDLINE

 

 

Diabetes Care.

2008 Feb;31 Suppl 2:S290-6.
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Is type 2 diabetes an operable intestinal disease? A provocative yet
reasonable hypothesis.

Department of Surgery, Catholic University of Rome, Rome,
Italy. frr2007@med.cornell.edu

Type 2 diabetes, which accounts for 90-95% of all cases of
diabetes, is a growing epidemic that places a severe burden on health care
systems, especially in developing countries. Because of both the scale of the
problem and the current epidemic growth of diabetes, it is a priority to find
new approaches to better understand and treat this disease. Gastrointestinal
surgery may provide new opportunities in the fight against diabetes.
Conventional gastrointestinal operations for morbid obesity have been shown to
dramatically improve type 2 diabetes, resulting in normal blood glucose and
glycosylated hemoglobin levels, with discontinuation of all diabetes-related
medications. Return to euglycemia and normal insulin levels are observed within
days after surgery, suggesting that weight loss alone cannot entirely explain
why surgery improves diabetes. Recent experimental studies point toward the
rearrangement of gastrointestinal anatomy as a primary mediator of the surgical
control of diabetes, suggesting a role of the small bowel in the pathophysiology
of the disease. This article presents available evidence in support of the
hypothesis that type 2 diabetes may be an operable disease characterized by a
component of intestinal dysfunction.

PMID: 18227499 [PubMed – indexed for MEDLINE]

 

 

Ann Surg.

2006 Nov;244(5):741-9.
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The mechanism of diabetes control after gastrointestinal bypass surgery
reveals a role of the proximal small intestine in the pathophysiology of type 2
diabetes.

IRCAD-European Institute of Telesurgery, University Louis
Pasteur, Strasbourg, France. f.rubino@lycos.com

SUMMARY BACKGROUND DATA: Most patients who undergo Roux-en-Y
gastric bypass (RYGB) experience rapid resolution of type 2 diabetes. Prior
studies indicate that this results from more than gastric restriction and weight
loss, implicating the rearranged intestine as a primary mediator. It is unclear,
however, if diabetes improves because of enhanced delivery of nutrients to the
distal intestine and increased secretion of hindgut signals that improve glucose
homeostasis, or because of altered signals from the excluded segment of proximal
intestine. We sought to distinguish between these two mechanisms. METHODS:
Goto-Kakizaki (GK) type 2 diabetic rats underwent duodenal-jejunal bypass (DJB),
a stomach-preserving RYGB that excludes the proximal intestine, or a
gastrojejunostomy (GJ), which creates a shortcut for ingested nutrients without
bypassing any intestine. Controls were pair-fed (PF) sham-operated and untreated
GK rats. Rats that had undergone GJ were then reoperated to exclude the proximal
intestine; and conversely, duodenal passage was restored in rats that had
undergone DJB. Oral glucose tolerance (OGTT), food intake, body weight, and
intestinal nutrient absorption were measured. RESULTS: There were no differences
in food intake, body weight, or nutrient absorption among surgical groups. DJB-treated
rats had markedly better oral glucose tolerance compared with all control groups
as shown by lower peak and area-under-the-curve glucose values (P < 0.001 for
both). GJ did not affect glucose homeostasis, but exclusion of duodenal nutrient
passage in reoperated GJ rats significantly improved glucose tolerance.
Conversely, restoration of duodenal passage in DJB rats reestablished impaired
glucose tolerance. CONCLUSIONS: This study shows that bypassing a short segment
of proximal intestine directly ameliorates type 2 diabetes, independently of
effects on food intake, body weight, malabsorption, or nutrient delivery to the
hindgut. These findings suggest that a proximal intestinal bypass could be
considered for diabetes treatment and that potentially undiscovered factors from
the proximal bowel might contribute to the pathophysiology of type 2 diabetes.

PMID: 17060767 [PubMed – indexed for MEDLINE]

 

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