Treatment of diabetes mellitus: A new approach through surgery

The economic, medical, and social burden of diabetes is immense. Given our current inability to achieve major remission and reduce death rates with medical management, metabolic surgery represents a new frontier in diabetic treatment. Over the past 20 years, bariatric surgery has proven successful in treating not just obesity but also type 2 diabetes.

Surgery should now be looked at as a viable therapy not only for the morbidly obese but also for diabetic patients who fall outside current BMI guidelines. The potential benefits of metabolic surgery are in fact enormous. Such gastrointestinal surgery has helped regularize normal blood glucose and glycosylated hemoglobin levels without the use of diabetes-related medicines. The mechanism of diabetes resolution after bariatric remains unclear but is apparently not related to weight loss alone. The antidiabetic mechanism of the surgery may be from a combination of hormonal changes seen after exclusion of the proximal intestine and increasing nutrient delivery to the distal small bowel.

A new approach through surgery:

Various surgeries geared toward the treatment of diabetes and not necessarily to induce weight loss are the duodenal-jejunal bypass, ileal transposition and Endoluminal Duodenal jejuna bypass sleeve surgery.

1. Duodenal-jejunal bypass is a stomach sparing bypass of a short segment of the proximal intestine, a gastric bypass without the stomach stapling.
2. leal transposition involves the removal of a small segment of the ileum with its vascular and nervous supply and inserting it into the proximal small intestine.

Endoluminal duodenal-jejunal bypass sleeve entails the endoscopic delivery and anchoring of a plastic-coated sleeve implant that extends into the jejunum and effectively excludes the duodenum.

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