The mystery of why a gastric bypass helps diabetes is closer to being resolved

by Barbara Hewitt on July 29, 2013

The mystery of why a gastric bypass helps diabetes is closer to being resolved

The mystery of why a gastric bypass helps diabetes is closer to being resolved

Scientists in the United States have taken a step forward in discovering how gastric bypass surgery helps type 2 diabetes. Existing research has shown that type 2 diabetes is often resolved after surgery and before the weight loss occurs but the reasons have remained unclear.

Now a research team led by Dr Nicholas Stylopoulos of Boston Children’s Hospital’s Division of Endocrinology, has identified the small intestine, widely believed to be a passive organ, as the major contributor to the body’s metabolism. The team has spent a year studying rats and found that after gastric bypass surgery the small intestine changes the way it processes glucose. The team saw the intestine using and disposing of glucose thereby regulating blood glucose levels in the rest of the body and helping to resolve type 2 diabetes.

‘We have seen type 2 diabetes resolve in humans after gastric bypass, but have never known why. People have been focusing on hormones, fat and muscle, but we have shown in this study that the answer lies somewhere in the small intestine most of the time,’ explained Stylopoulos. Gastric bypass surgery, a weight loss treatment typically reserved for severely obese patients, reroutes food into the smaller pouch of the stomach and bypasses the rest of the stomach and duodenum.

Quote from : “First patient receives innovative new treatment to tackle combined diabetes and obesity in NHS approved trial initiated by the ABCD, UK.”

Before a gastric bypass, intestines typically do not contain a specific transporter called GLUT-1, which is responsible for removing glucose from circulation and utilising it within the organ. After surgery the researchers found that the intestine reprogrammes itself to contain GLUT-1, taking glucose from circulation and disposing of it, swiftly stabilising blood glucose levels in the rest of the body. ‘Previously, we had not considered the intestine as a major glucose utilising organ. We have found this process is exactly what happens after surgery,’ added Stylopoulos.

Based on their findings, Stylopoulos and his colleagues found type 2 diabetes was resolved in 100% of the rats that underwent gastric bypass. Some 64% of type 2 diabetes was resolved by the intestine, and the researchers hypothesise that the other 36% may be due to weight loss or other factors. These findings pave the way for future investigations of how to create a medical pathway to mimic the intestine’s reprogramming without the surgery. ‘With further research, we may find ways to bypass the bypass. The results of our study are promising because, unlike the brain and other organs, intestines are easily accessible. Furthermore, since cells in the intestine have such a short lifespan, we can easily study and pharmacologically manipulate them to use glucose, without long term problems,’ said Stylopoulos.

The research has been supported with funds from the National Institutes of Health and the Division of Endocrinology, Department of Medicine and the Clinical and Translational Executive Committee at Boston Children’s Hospital.

The opinions expressed in this article do not necessarily reflect the views of the Community and should not be interpreted as medical advice. Please see your doctor before making any changes to your diabetes management plan.

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