Patients with obese diabetes that have gastric bypass weight loss surgery often show dramatic improvement in blood sugar control in a few days, long before significant weight loss occurs.
The reversal of type 2 diabetes tends to occur much faster than with gastric bands, and a new study can help explain why.
The discoveries can also advance the search for best treatments of diabetes that aim at the small intestine and not the pancreas, say the researchers say.
"It is increasingly clear that the intestine is not only a conduit for food traffic," Francesco Rubino gastric surgeon, MD, says WebMD. "Now we know that it is also a very important organ for the regulation of glucose."
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Because weight loss alone can not explain the rapid remission of diseases in many patients with gastric bypass, the researchers sought other causes.
A theory has been this surgery alters the expression of hormones that help control appetite, blood sugar and weight.
But studies designed to test this hypothesis have proven contradictory, diabetes researcher Gilles Mithieux WebMD account.
In his newly published study, reported in the September edition of the magazine's cell metabolism, Mithieux and colleagues seemed elsewhere for answers.
"We know of an earlier work that the small intestine can produce glucose," he says. "We show that with gastric bypass surgery you essentially double the intestinal capacity to do this."Studying mice treated with bypass or gastric bands, researchers confirmed that bypass operation was associated with increasing glucose production, or blood sugar, thin intestine, while the gastric band was not.
. Gastric bypass surgery essentially produces a "couple intestine," says Mithieux. The portion of the small intestine that is closest to the stomach is ignored so that it does not receive more nutrients. The lower small intestine is then connected to the stomach, where the main nutrient receiver becomes.
When surgically reposition the lower small intestine, which usually does not produce much glucose, it increases the production of intestinal glucose and improves insulin sensitivity, he says.
Rubino tells WebMD that the discoveries offer important insights about the role of the small intestine in the regulation of blood sugar.
"That does not tell the whole story, but it seems to be an important piece of the puzzle," he says.The gastric bypass surgeon is a strong advocate of using surgery as a first-line treatment for type 2 diabetes - a position that remains controversial.
He directs the Diabetes Surgery Center at the Hospital New York-Presbyterian / Weill Cornell Medical Center.
"The surgery promises to be one of the most powerful features we have to fight against this disease," he says. "I do not think it's the answer to everyone. But for patients with the right profile, the results can be remarkable." Rubino believes that surgery can help not only diabetic patients who are morbid obese but also people overweight but do not weigh enough under the current guidelines to be considered for the gastric bypass procedure."We hope to study this to see if surgery is better than conventional treatment in patients who are moderately obese or just overweight," he says.
