A substantial body of medical literature shows that many Type 2 diabetic patients who undergo gastric bypass surgery achieve normalization of blood sugars and can even discontinue their diabetes medications. "This phenomenon puzzles clinicians and scientists," says Dr. Rubino. "Is diabetes cured? What happens to it? We are left scratching our heads because this has no precedent in the history of diabetes treatments."

The idea of surgery as an approach with curative intent for diabetes has been gaining support. In the November 2009 issue of Diabetes Care, the official publication of the American Diabetes Association (ADA), a group of 12 clinical experts, including Dr. Rubino, published a consensus statement that defined diabetes remission as a condition where normal blood sugar levels can be maintained without the need for continuous pharmacological treatment. "This consensus statement implicitly recognizes that the only current intervention with potential for inducing remission of diabetes is surgery," says Dr. Rubino. "It is a huge conceptual shift if one considers that diabetes is typically regarded as a chronic and invariably progressive illness."

Broadening Access to the Surgical Option

At NewYork-Presbyterian/Weill Cornell, Dr. Rubino performs the standard Roux-en-Y bypass procedure in patients with a BMI over 35, who form the greater part of his practice. Most of them come to him seeking treatment for both obesity and Type 2 diabetes. Now, the potential benefits of intestinal bypass are being extended to 50 non-obese patients as part of the current study.

Dr. Rubino's efforts have already begun to affect a shift in diabetes treatment guidelines at the highest level. In 2007, he was the lead organizer of the first Diabetes Surgery Summit, held in Rome. The conference issued a set of recommendations, recently published in the Annals of Surgery, regarding the use of surgery as a diabetes-specific treatment. Additionally, the ADA has now recognized diabetes surgery as a viable option for people with BMI of 35-plus in a 2009 supplement to its Standards of Medical Care in Diabetes document. Both the ADA and the DSS consensus statement emphasized the importance of clinical trials to investigate the role of surgery in the treatment of diabetes in patients with a lesser degree of obesity.

Source: NewYork-Presbyterian Hospital/Weill Cornell Medical Center