Surgery of the Upper Intestine May Correct Diabetes

A new study shows that intestinal surgery may effectively cure type 2 diabetes, an approach that not only may change the way the disease is treated, but that introduces a new way of thinking about diabetes.

A researcher at the New York-Presbyterian Hospital/Weill Cornell Medical Center (New York, NY, USA) performed surgery in animals suffering from diabetes that showed that procedures based on gastrointestinal bypass of the upper small intestine (specifically the duodenum and jejunum) causing nutrients' passage to be diverted, reverses abnormalities of blood glucose regulation. This diabetes remission was established independently of any weight loss, and even in subjects that were not obese. This, according to researcher, implies that the upper intestine of diabetic patients may be the site where an abnormal signal is produced, causing, or at least favoring, the development of the disease.

The researcher, Francesco Rubino, M.D., chief of gastrointestinal metabolic surgery at Weill Cornell, proposed that the explanation for this finding could be the ‘anti-incretin theory'. Incretins are gastrointestinal hormones produced in response to the transit of nutrients that boost insulin production. Because an excess of insulin can determine hypoglycemia, the body has a counter-regulatory mechanism (the ‘anti-incretin' mechanism), activated by the same passage of nutrients through the upper intestine. The latter mechanism would act to decrease both the secretion and the action of insulin. In healthy patients, a correct balance between incretin and anti-incretin factors maintains normal excursions of sugar levels in the bloodstream; however, in some individuals, the duodenum and jejunum may be producing too much of this anti-incretin, thereby reducing insulin secretion and blocking the action of insulin, ultimately resulting in type 2 diabetes. After gastrointestinal bypass procedures, the exclusion of the upper small intestine from the transit of nutrients may offset the abnormal production of anti-incretin, thereby resulting in remission of diabetes. The study was published in a special supplement to the February 2008 issue of Diabetes Care.

"It should not surprise anyone that surgically altering the bowel's anatomy affects the mechanisms that regulate blood sugar levels, eventually influencing diabetes,” said Dr. Rubino. "By answering the question of how diabetes surgery works, we may be answering the question of how diabetes itself works.”

"The lesson we have learned with diabetes surgery is that diabetes is not always a chronic and relentless disease, where the only possible treatment goal is just the control of hyperglycemia and minimization of the risk of complications. Gastrointestinal surgery offers the possibility of complete disease remission,” he added. "This is a major shift in the way we consider treatment goals for diabetes. It is unprecedented in the history of the disease.”


Related Links:
NewYork-Presbyterian Hospital/Weill Cornell Medical Center