New data presented at the recent AACE meeting shows that metabolic surgery, a new surgical approach to metabolic disease, may provide the key to curing diabetes in some patients. However, if the result is normal blood sugars for Type 2 patients without medications, is it a cure?
Chief of Gastrointestinal Metabolic Surgery at Weill Cornell Medical College, Francesco Rubino, MD, said, “This goes beyond just weight-loss surgery…. For its clinical potential, and maybe even more for its implications for the understanding of diabetes, metabolic surgery is one of the most important research opportunities for the next decade in medicine.”
According to Dr. Rubino, a growing body of evidence suggests that the mechanisms of diabetes resolution after surgery involve intestinal signals, “I am confident that we may see important discoveries occur as we direct our attention to the role of the bowel in diabetes.”
Recent studies have indicated that bariatric surgery, an approach typically used to treat severe obesity, often results in normalization of blood sugar levels and other metabolic abnormalities. This results in a reduction of the overall risk of mortality associated with diabetes in severely obese patients.
Dr Rubino’s personal research showed for the first time that the effects of bariatric surgery on diabetes cannot be entirely explained by weight loss, and are intrinsic with the change of intestinal anatomy characteristic of these procedures. As a result, experts have been studying the biological impacts of the surgery on mechanisms of glycemic control, and are exploring the possibility of using gastrointestinal surgery to treat diabetes per se.
“It would be premature at this point to argue every diabetes patient is a candidate for gastrointestinal surgery,” Dr. Rubino said. “However, there is enough evidence that surgery should be considered as an option to endocrinologists in the treatment of Type 2 diabetes.”
Metabolic surgery is the result of a collaborative effort between endocrinologists and surgeons working to optimize the surgery for diabetes patients. Together they can formulate a “tailored intervention,” designing procedures that allow them to gain a greater understanding of how the disease works.
“Recognizing the need to work as a team across disciplines that includes endocrinologists and surgeons is the first critical step to address the issues and opportunities that surgery offers to diabetes care and research,” Dr. Rubino said.
Thus far the results are intriguing. “This collaborative effort is helping us gain a broader, more comprehensive understanding of diabetes,” Rubino said. “In the end it will pay dividends for patients.”
Presented at the AACE Meeting, May 2009