Researchers at East Carolina University in Greenville are using gastric bypass surgery to help patients with diabetes.
Diabetes is rampant in eastern North Carolina where 11 percent of the population suffers from the ill effects of diabetes where if left untreated can lead to blindness, amputation, heart and kidney damage and even death. Socioeconomic status, a lack of preventative education and poor access to healthcare in rural areas has caused the prevalence of diabetes in eastern North Carolina to surpass the state and national average.
“It is an epidemic here and it is my belief that we have one of the diabetes rates in the United States.”
Dr. Walter Pories is the Professor of Surgery, Biochemistry and Kinesiology at East Carolina University’s Brody School of Medicine in Greenville. He’s the man behind a groundbreaking idea that over time has proven to be true. More than 20 years ago, Dr. Pories and a team of researchers at ECU were the first to report that weight loss surgery could reverse the effects of diabetes.
“it’s been quite remarkable because we’ve thought this was an incurable, progressive disease, and with a fairly simple operation that takes about an hour, you can cure it.”
Most recently, the American Diabetes Association recognized that gastric bypass surgery should be the standard of care for treating Type 2 diabetes.
Dr. Pories and his team of physicians began studying obesity in 1980. They performed weight loss surgeries on 837 patients over the span of 16 years and kept meticulous records on how their patients responded to the procedure.
“That then documented that they lost 1/3 of their weight and the weight stays off.”
The weight loss surgery performed as expected. But researchers were shocked when they realized the added benefit for diabetic patients.
“we’ve found that diabetes disappears in between two to four days completely. We didn’t believe this, we didn’t report this for three years. But the fact that we kept careful track of the patients proves that… of course, it’s been proven again and again. ”
In 2011, Greenville resident Canaan Flemming took the opportunity to have gastric bypass surgery after struggling with diabetes. For years, he took medications and insulin to manage the disease, to little or no avail.
“My weight was out of control, that was the main thing that caused diabetes. Then, blood pressure problems, and a lot of different other medical ailments that go along with blood pressure and diabetes. So I needed to do something.”
A day after the surgery, Flemming said the doctor measured his blood sugar and took him off insulin.
“I mean, I’ve had some ups and downs, nothing really bad. But I came off my insulin completely and I’ve not used insulin in four and a half years since my laparoscopic surgery. No insulin.”
The official journal from the American Diabetes Association states there is sufficient clinical and mechanistic evidence to support inclusion of metabolic surgery among antidiabetes interventions for people with type 2 diabetes and obesity. Bariatric Surgeon at East Carolina University Dr. Matthew Burrus says insurance requires patients to have a body mass index of 35 or greater and diagnosable comorbidities to receive the Roux-en-Y gastric bypass surgery.
“In that procedure, we make the stomach about the size of an egg and bypass roughly a 100 cm of the small intestines. We don’t actually remove anything in doing this. And depending on how severe the patient’s diabetes is when the surgery is performed, typically if they have less than 5 years, it’s about an 80 percent chance of resolution of the diabetes.”
Their research shows diabetes is cured for a couple of decades. After the surgery, most patients can stop taking medications and insulin. But, why does the surgery reverse diabetes?
“I think that’s the million dollar question and there’s a lot of research going on with that. We don’t actually know the mechanism of why that cures diabetes but it does it immediately, meaning it’s not the weight loss that cures the diabetes, it’s something in what we do in the surgery.”
Now that researchers at ECU know how to cure diabetes, Dr. Walter Pories says they want to know what causes it. He says they’re actively involved in diabetes research focusing on signaling between the foregut and mitochondria.
“It may well be an abnormal signal that comes from the intestine, goes through the blood stream, and then affects most of the cells in the body to some degree so that they don’t use sugar and fat as efficiently as they should. And that’s really what our research is about, finding out the mechanism for diabetes.”
The surgery is not without downsides. The procedure costs around $18,000 and as with any surgery, there are risks involved such as bleeding and infection. In rare cases, leakage can occur at the connection where the intestine meets the newly created stomach pouch.
“Many studies have been done, and it’s less than one percent of the time and it’s actually as safe as getting your gallbladder out.”
Life after the procedure takes adjustment. Patients must adhere to dietary limitations and take vitamin and mineral supplements to avoid deficiencies. For those managing diabetes, the advantages of the gastric bypass procedure may outweigh the risks. Greenville resident Canaan Flemming lost 90 pounds and says it’s helped him get his health back.
“Yeah, I made up my mind. I don’t want to go back to shooting needles in my thigh. I got tired of that. I keep a needle and insulin in my refrigerator to remind me that I’ve got to do right.”
For more information on Metabolic Surgery in the Treatment Algorithm for Type 2 Diabetes: A Joint Statement by International Diabetes Organizations, go to: http://care.diabetesjournals.org/content/39/6/861