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Return to Growing Evidence Surgery Can Cure Type 2 Diabetes Overview

More on Growing Evidence Surgery Can Cure Type 2 Diabetes

Growing Evidence Surgery Can Cure Type 2 Diabetes

New York (Mar 23, 2010)

Surgeon puts on gloves

Physicians and scientists at NewYork-Presbyterian have pioneered metabolic surgery for the treatment of type 2 diabetes – an approach that not only may change the way the disease is treated, but that introduces a revolutionary way of thinking about diabetes as an operable intestinal disease.

Type 2 diabetes, associated with severe obesity, is a growing epidemic that accounts for 90-95% of all cases of diabetes and currently affects more than 200 million people worldwide. It is a leading cause of death and number one cause of blindness, kidney failure and amputation. Until recently, it has been considered a relentless and progressive disease. In patients with severe obesity, metabolic weight-loss surgery dramatically improved diabetes, often resulting in normalization of blood sugar levels and no need for diabetes medication. What is striking is that the resolution of diabetes occurs almost immediately after surgery – suggesting that decreased caloric intake and weight loss alone cannot entirely explain why surgery improves diabetes.

Dr. Francesco Rubino
Dr. Francesco Rubino

Dr. Francesco Rubino, Chief of Gastrointestinal Metabolic Surgery at NewYork-Presbyterian/Weill Cornell Medical Center, demonstrated that gastric bypass surgery can improve diabetes through direct anti-diabetic mechanisms that are at least in part independent of weight loss. Based on his research findings Dr Rubino proposed an original scientific theory, which suggest that a malfunctioning of the gastrointestinal tract could contribute to the development of type 2 diabetes.

In fact, research has confirmed that 83% of patients experience a complete remission of type 2 diabetes after gastric bypass surgery. Metabolic surgeons, endocrinologists and basic scientists are now working to understand the reasons behind this unexplained benefit.

Dr. Judith Korner
Dr. Judith Korner

Judith Korner, M.D., Ph.D., Director of the Weight Control Center at NewYork-Presbyterian/Columbia University Medical Center, explains "Delivery of nutrients to the distal gut may help to stimulate hormones that regulate insulin producing cells in the pancreas and blood glucose. We are not sure whether the resolution of diabetes is caused by bypassing the foregut (upper small intestine) or rapid delivery of nutrients to the distal gut, or both."

Dr. Rubino adds, "It has become increasingly evident that the gastrointestinal tract, and the small bowel in particular, play an important role in the regulation of blood sugar levels, fat metabolism, and the control of appetite and body weight. When we bypass the upper small intestine – especially duodenum and jejunum – we are bypassing what may be the source of the problem." This hypothesis represents a whole new paradigm, which characterizes type 2 diabetes as an intestinal disease, potentially curable by surgical treatment.

Video with Dr. Rubino
Video: Dr. Rubino talks about
metabolic surgery.
(watch video)

There is also growing evidence that bypass surgery can be effective even for patients who are only slightly obese or just overweight, suggesting that current Body Mass Index (BMI) cut-offs used to determine who is an ideal candidate for surgical treatment of diabetes are no longer adequate. Two studies are underway at NewYork-Presbyterian/Weill Cornell and New-York Presbyterian/Columbia to explore surgically treating type 2 diabetes in people who are just moderately obese and comparing surgical results with individuals treated with intensive life-style and medical management. Results of these studies may expand the current BMI criteria used to determine eligibility for bypass surgery to treat diabetes.

"By answering the question of how diabetes surgery works," says Dr. Rubino, "we may be answering the question of how diabetes itself works."

For More Information

  • Information about the NewYork-Presbyterian/Columbia study is available by calling 212-305-0486.
  • Information about the NewYork-Presbyterian/Weill Cornell study is available by calling 212-746-5925.

Francesco Rubino, M.D.,is the Chief of Gastrointestinal Metabolic Surgery and an Associate Attending Surgeon at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. He is also an Associate Professor of Surgery at Weill Cornell Medical College.

Judith Korner, M.D., Ph.D., is an Assistant Attending Physician at NewYork-Presbyterian Hospital/Columbia University Medical Center and the Florence Irving Assistant Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons.

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