Cornell University has been a world leader in conducting research showing that bariatric surgery dramatically outperforms the usual medical treatment for Type 2 diabetes.
In 2012, the results of a 2-year randomized study published in The New England Journal of Medicine showed that most bariatric surgery patients were able to discontinue all diabetes medications and maintain disease remission for the two-year study period, while none of those randomly assigned to receive standard medical treatment did.
It is particularly challenging to treat obese patients who have Type 2 diabetes, because insulin therapy and other hypoglycemic medications often cause additional weight gain.
“Although bariatric surgery was initially conceived as a treatment for weight loss, it is now clear that surgery is an excellent approach for the treatment of diabetes and metabolic disease,” said senior author Dr. Francesco Rubino, chief of Gastrointestinal Metabolic Surgery and director of the Metabolic and Diabetes Surgery Center at New York-Presbyterian/Weill Cornell and associate professor of surgery at Weill Cornell Medical College at the time.
No one has fully understood the mechanisms behind these effects, but a more recent Cornell-led study published in the journal Gut provides clues to the mystery. The study, which was done with mice, reveals that bariatric surgery increases bile acid concentrations, and in concert with a bile acid receptor, play critical roles in balancing glucose levels in the body, which help treat diabetes.
In the study, the researchers conducted either a sham surgery or a common bariatric surgery called a vertical sleeve gastrectomy (VSG) in mice on a high fat diet. In a VSG, surgeons cut along the curve of the stomach and remove roughly 70 percent, leaving a tubular organ. The sham surgery created sutures in the stomach but didn’t remove any stomach tissue, to test if surgery itself contributed to effects. A third group of normal mice were given a sham surgery but were also placed on a restricted diet to control for weight loss.
Clinicians found that diabetes remission begins within days after surgeries, well before any weight loss occurred.
In the future, there may be new drugs for bile acid concentrations and receptors to control diabetes, but until then, studies continue to prove that diabetes goes into remission just days after bariatric surgery. This is wonderful news for anyone with Type 2 diabetes, who has had trouble controlling their disease.