Gastric Bypass Surgery Explored as Cure for Type 2 Diabetes

A bariatric surgery procedure used for treating severe obesity is now being explored as a cure for type 2 diabetes mellitus in normal-weight and moderately overweight patients with diabetes. Specific recommendations for using surgery in these patients are expected to appear this summer, according to a presentation here at the annual meeting and clinical congress of the American Association of Clinical Endocrinologists. When used as a last resort for weight management, certain gastric bypass procedures have been known to completely reverse, or at least mitigate, type 2 diabetes. Until recently, researchers had assumed that weight loss alone was somehow responsible for this benefit. However, new research in rodents and very preliminary work in humans suggest that hormonal and metabolic changes caused by the surgery must be responsible, not simple weight loss, said Karen Foster-Schubert, MD, acting instructor at the University of Washington in Seattle. "We really don't know what is being affected yet," Dr. Foster-Schubert told Medscape about the mechanism of diabetes reversal. Research in the laboratory of her colleague, David E. Cummings, MD, of the University of Washington, shows that ghrelin, a recently discovered peptide that stimulates appetite, is decreased after gastric bypass surgery. Other peptides, including the distal small intestine hormone peptide YY (PYY), and glucagon-like peptide 1 (GLP-1), secreted by intestinal L cells, increase after the operation, she said.