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Quality of Life Innovations from the Columbia University Department of Surgery

Metabolic Surgery: A New Option in Treating Type 2 Diabetes
Center for Metabolic and Weight Loss Surgery
Columbia University Medical Center
As increasing numbers of people have chosen bariatric surgery, doctors have observed and research
has confirmed that 83% of patients experience a complete remission of type 2 diabetes after gastric
bypass surgery (the gold standard in weight loss procedures) even before weight loss occurs. This is
enormously significant, given the devastating impact of diabetes on public health in the U.S., and
increasingly, throughout the world. Among those undergoing laparoscopic banding procedures, type 2
diabetes resolves in about half of patients—also tremendously significant. What is especially striking is
that the resolution of diabetes occurs almost immediately after surgery, and before significant weight
loss. Many patients can stop taking their diabetes medications shortly after surgery.
While resolution of diabetes after weight loss surgery clearly benefits those who are eligible for surgery (people with body mass index greater than 35), a
study underway at Columbia University Medical Center is investigating surgically treatment of type 2 diabetes in people who are not obese. Understanding
how weight loss surgery improves diabetes may lead to new ways of improving blood glucose control and ultimately help researchers identify a cure for type 2
diabetes.
Researchers believe that bypassing the upper part of the intestinal tract, the 'foregut,' through surgery may cause hormonal changes that lead to
improvement in diabetes. We know that the gut is a major player in diabetes resolution, that there is a pathway of communication between beta cells (insulin
producing cells in the pancreas), the hunger center in the brain, and adipose tissue.
The gastrointestinal tract is the largest and most active endocrine organ in the body, and produces more than 100 hormones. One theory holds that after
gastric bypass surgery, nutrients are delivered more quickly to the 'hindgut,' or the lower portion of the intestinal tract, where certain hormones such as GLP1
are released. GLP1 acts on beta cells, which make insulin. Investigators at Columbia believe that delivery of nutrients to the distal gut may help to stimulate
hormones that regulate blood glucose, but it is unknown whether the resolution of diabetes is caused by bypassing the foregut, or rapid delivery of nutrients
to the distal gut, or both.