Introduction
Diabetes affects more than 100 million citizens of the United States with a large section of the population either experiencing type-2 diabetes or prediabetes that might lead to the development of type-2 diabetes (“New CDC report,” 2016). A great variety of treatments and diagnostic techniques have been researched and proposed over the last few decades in an attempt to find an effective and safe resolution to this issue. One such treatment includes a food-diverting operation designed specifically as a solution to type-2 diabetes. This paper will provide an overview of the treatment, and the clinical findings revealed by the research.
Background Information
In the introductory section, the authors of the research paper state that bariatric operations have previously shown to be highly effective when attempting to induce a remission of type-2 diabetes in the patient (Fried et al., 2017; Ren, Duan, & Cao, 2018). Such operations include procedures designed to divert food and biliopancreatic secretions to the distal small bowel. More sophisticated operations have recently been developed specifically for non-morbidly obese patients. The paper specifically focuses on patients with BMI between 25 and 35 kg/m2. Side-to-side jejunoileal anastomosis was originally added to the procedure of sleeve gastrectomy as a method of weight loss enhancement. However, this research paper examines its potential use for treatment of type-2 diabetes in patients within the previously stipulated BMI range (Melissas et al., 2017).
The Proposed Treatment
The proposed treatment includes a simple food diversion operation of the side-to-side jejunoileal anastomosis. The authors hypothesized that by bypassing a major section of the small bowel through this operation in non-morbidly obese diabetic patients, the incretin production would be stimulated. Before attempts to perform this operation on humans, the hypothesis was tested on animals such as rats to establish the possible effectiveness of the procedure. The examined results were positive in nature, which prompted the transition to human patients. These results were also strengthened by the remission of diabetes in patients who previously experienced the gastric bypass and biliopancreatic diversion operations. The fast transportation of food into the distal ileum increases the production o incretins and normalization of glucose metastasis (Melissas et al., 2017).
For the research of the treatment, the authors assembled a group of six people between ages 35 and 60 with BMI 28-32 kg/m2. The research was cleared by the ethics committee of the Heraklion University Hospital, Medical School University of Crete, and authorities of Istanbul University Cerrahpasa Medical Faculty. The treatment involved a simple surgical operation, and none of the patients experienced any discomfort during or after the operation. The majority of the patients was older than 50 years old and experienced a variety of accompanying medical conditions, such as hypertension. The only patient younger was 35 years old and did not experience any additional negative conditions (Melissas et al., 2017).
Clinical Findings
The clinical findings on the matter were extensive and informative. After the operation, all of the participating patients experienced significant weight loss over the period of six months. The number of lost kilos differed between the patients, from 8 to 15 kilograms per patient. Approximately 11.9% of the patients’ weight was lost after the operation. In the follow up after 24 months after the operation, the patients regained a portion of their weight, but none have gone above the preoperative values. These results are consistent with the use of this operation in similar food-diverting treatments. The FBG levels of the patients were self-reported by them for the first four weeks after the operation. Immediately after the operation, the levels were at 96.7 mg/dl. On the first, third, and sixth month after the operation, the patients have shown significantly lower FBG values. However, after longer periods of study, the levels did not show a continuation of decline. Glycosylated hemoglobin levels have also shown significant changes in the postoperative months. They have lowered by almost 8 percent by the sixth visit to the patients. All of the patients that experienced the treatment have experienced either total or partial remission of type-2 diabetes shortly after the operation. The clinical findings are considered highly encouraging by the authors. However, they advocate for further research in the mechanism of diabetes control based on the effects caused by this treatment (Melissas et al., 2017).
Conclusion
Diabetes is an extremely important issue in the United States. With millions of people experiencing it on a daily basis or being at risk of its development, effective treatment could be of great use to the medical community. The results achieved through the food diversion operation presented by the authors are very positive. However, the participant sample was very small. In addition, the treatment was focused only on non-morbidly obese patients with BMI 28-32 kg/m2. This treatment may not provide the same positive results when it is applied to patients with different BMI levels. Nevertheless, if this treatment proves to be a consistent method of remission induction in patients with type-2 diabetes, even if it is only effective for the specified group of people, it should become one of the standard procedures. Hopefully, these results will prove to be useful in the future.
Bullet Points
Introduction
- Diabetes affects more than 100 million Americans;
- Type-2 diabetes is a very common condition;
- Over the years, treatments have been proposed;
- One diabetes treatment examined in the paper;
- Simple food diversion operation as diabetes treatment;
- Overview of the treatment and clinical findings;
Background Information
- Food diversion operations previously successfully induced remission;
- Designed to divert food and biliopancreatic secretions;
- Was developed specifically for non-morbidly obese patients;
- Side-to-side jejunoileal anastomosis was for weight loss;
- This treatment has previously shown positive results;
- Can be used for type-2 diabetes remission;
The Treatment
- Food diversion operation of side-to-side jejunoileal anastomosis;
- Bypassing a section of the small bowel;
- The incretin production would be effectively stimulated;
- Procedure was previously successfully tested on animals;
- Gastric bypass and biliopancreatic diversion operations;
- Production of incretins and glucose metastasis;
Participants
- Six patients with type-2 diabetes participated;
- They were between ages 35 and 60;
- Everyone had BMI within 28-32 kg/m2;
- Cleared by relevant local ethics committees;
- Majority were older than 50 years old;
- Some experienced hypertension before the operation;
Clinical Findings
- Patients lost from 8 to 15 kilograms;
- FBG levels of the patients significantly reduced;
- Glycosylated hemoglobin levels lowered by 8 percent;
- Total or partial remission of type-2 diabetes;
- Positive results achieved by all patients;
- No issues experienced after the operation;
Conclusion
- Diabetes is an extremely serious issue;
- Effective solution is required to treat patients;
- Results of the treatment were positive;
- However, they do not apply to everyone;
- Participant sample size was too small;
- Further research is required to control diabetes.
References
Fried, M., Dolezalova, K., Chambers, A. P., Fegelman, E. J., Scamuffa, R., Schwiers, M. L., … Seeley, R. J. (2017). A novel approach to glycemic control in type 2 diabetes mellitus, partial jejunal diversion: pre-clinical to clinical pathway. BMJ Open Diabetes Research and Care, 5(1), 431.
Melissas, J., ErenTaskin, H., Peirasmakis, D., Dimitriadis, E., Papadakis, M., Zengin, S. U., … Taskin, M. (2017). A simple food-diverting operation for type 2 diabetes treatment. preliminary results in humans with BMI 28–32 kg/m2. Obesity Surgery, 27(1), 22–29.
New CDC report: More than 100 million Americans have diabetes or prediabetes. (2016). Web.
Ren, Q., Duan, J., & Cao, J. (2018). Rapid improvement in diabetes after simple side-to-side jejunoileal bypass surgery: Does it need a ligation or not? Obesity Surgery, 1–6.