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Is Type 2 Diabetes an Operable Intestinal Disease?

A provocative yet reasonable hypothesis

From the Department of Surgery, Catholic University of Rome, Rome, Italy

Address correspondence and reprint requests to Francesco Rubino, MD, Section of Gastrointestinal Metabolic Surgery, Department of Surgery, Weill Medical College of Cornell University-New York Presbyterian Hospital, 525 East 68th St., P.O. Box 294, New York, N.Y. 10021. E-mail: frr2007{at}med.cornell.edu

Type 2 diabetes, which accounts for 90–95% of all cases of diabetes, is a growing epidemic that places a severe burden on health care systems, especially in developing countries. Because of both the scale of the problem and the current epidemic growth of diabetes, it is a priority to find new approaches to better understand and treat this disease. Gastrointestinal surgery may provide new opportunities in the fight against diabetes. Conventional gastrointestinal operations for morbid obesity have been shown to dramatically improve type 2 diabetes, resulting in normal blood glucose and glycosylated hemoglobin levels, with discontinuation of all diabetes-related medications. Return to euglycemia and normal insulin levels are observed within days after surgery, suggesting that weight loss alone cannot entirely explain why surgery improves diabetes. Recent experimental studies point toward the rearrangement of gastrointestinal anatomy as a primary mediator of the surgical control of diabetes, suggesting a role of the small bowel in the pathophysiology of the disease. This article presents available evidence in support of the hypothesis that type 2 diabetes may be an operable disease characterized by a component of intestinal dysfunction.

Abbreviations: BPD, bilio-pancreatic diversion • DJB, duodeno-jejunal bypass • GIP, gastric inhibitory peptide • GLP, glucagon-like peptide • RYGB, Roux-en-Y gastric bypass

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