Diabetes: A Surgical Cure?
A chronic disease that afflicts more than 200 million people worldwide, type 2 diabetes takes a huge toll on those with the disease. Over time, many patients are faced with potentially deadly complications affecting the kidneys, eyes, heart and extremities. For the most part, treatments such as diet, hypoglycemic medications, and insulin are ineffective in advanced disease.
Still, says Dr. Rubino, most of us don’t think of diabetes as a surgically treatable condition. Diet and exercise go far toward preventing the disease, which is why he agrees that preventive and primary care should receive priority in the realm of health care policy and planning. The problem is that lifestyle changes around diet and exercise have little or no impact on advanced disease, in which metabolic changes take on a life of their own and begin to ravage the body.
“Telling a patient with severe diabetes to eat a low-fat diet and go to the gym is comparable to telling a person with lung cancer to stop smoking,” Dr. Rubino says.
As one of the founders of the specialty known as gastrointestinal metabolic surgery, Dr. Rubino has tracked the benefits of bariatric procedures — especially those that reroute rather than simply restrict the digestive tract — when performed in severely obese patients with diabetes. He and his colleagues have found that immediately after intestinal bypass surgery, the disease improves radically, often to the point of completeremission. These results, he says, appear to be unrelated to weight loss.
Based on earlier studies and on clinical experience in other countries, Dr. Rubino and his colleagues have found that removing portions of the jejunum or duodenum — the upper part of the small intestine right below the stomach — leads to spontaneous improvement or even resolution of diabetes. The same holds true when the surgeon simply inserts a tube in that part of the intestine, allowing food to pass through without coming into contact with the area. These findings suggest that when food normally passes from the stomach into the upper end of the small bowel, it triggers a cascade of hormonal reactions that cause diabetes. Understanding precisely how and under what circumstances such reactions occur is Dr. Rubino’s longer-term research goal.
Source: healthcanal.com
