Studies Indicate Lack of Correlation between Surgery and Diabetes Remission
For many years, weight loss has been considered one of the most effective ways of treating diabetes, especially type 2 diabetes. This idea was strengthened by hugely effective bariatric, or weight-loss, surgical procedures, such as gastric banding and gastric bypass surgery. However, recent discoveries have brought this concept into question.
While non-surgical diabetes treatments, such as medication and dieting have shown a 13 percent success rate in eliminating diabetes after two years, gastric banding, which is one form of bariatric surgery, has seen success rates ranging from 50 percent to as high as 73 percent within the same time frame. Bariatric surgery is also a relatively safe procedure, with only a 0.3 percent chance of fatality within 30 days of the surgery. The American Diabetes Association, though, recommends these procedures only to individuals with a Body Mass Index, a measurement of the amount of fat in the body based solely on weight and height, of 35 or more. This has severely limited the treatment patients with a lower BMI can receive.
In 2009, as part of his research on the disease, Dr. Francisco Rubino, a proponent of treating patients in this manner, performed bariatric surgery on these individuals with a BMI under 35. He altered a typical gastric bypass, officially known as Roux-en-Y, which has already shown a success rate of 80 to 85 percent. In this procedure, the stomach is clamped to limit the patient’s intake of food, and then forces the nutrients to completely skip the beginning of the small intestine, called the duodenum, redirecting the food to the end of it, the jejunum, instead. Rubino’s duodenal-jejunal bypass, DJB, cuts out the portion of the surgery involving the stomach.
Although Rubino used this procedure to help treat people who would not normally receive such treatment, he made a surprising observation, one that went against common knowledge. As with other bariatric procedures, his patients lost weight afterward. However, the rate at which their blood glucose levels normalized was much greater than the rate at which they lost this weight. Rubino concluded that some other aspect of the procedure was the reason for its success, rather than the weight loss. In effect, he hypothesized that diabetes could be treated independently of weight-loss.
In May, researchers at the University of Toronto potentially explained Rubino’s observations. By testing on rats, which had undergone gastric bypass surgery, the scientists concluded that when the nutrients the animals took in reached the jejunum, it sent a signal to the brain, informing it that glucose had reached that point in the intestines. The body registered this as what could essentially be considered a glucose overdose and limited its glucose production. According to their study, the treatment appears to work for both type 1 and type 2 diabetes.
Researchers like Rubino hope that within the next few years, this procedure will be recommended by the American Diabetes Association in general practice, not just for research purposes. It could prevent future diabetes patients from having to worry about failing kidneys or losing their feet to the disease.
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