#02. History of the Diabetes Surgery

Every two years, the International Diabetes Federation publishes a new set of data on the prevalence of diabetes worldwide. Current demographics show that the number of people with diabetes continues to rise. 1 in 11 adults has diabetes, which means that more than 425 million people are affected worldwide. To tell you the truth, the most radical, rational and effective method would be to introduce drastic changes in the food and transport industries as well as in urban planning on the global scale, as the majority of problems lie in our contemporary lifestyle and diet. Let’s look at the available data on sugar consumption and the prevalence of diabetes and obesity. There is a surprising geographical consistency here. Nevertheless, no institution, no industry or even state is presently taking any considerable measures to combat this dangerous trend.  In the previous episode, we mentioned the traditional therapy consisting of diet, exercise, oral medications and insulin intake. However, the present guidelines of the American Diabetes Society also feature surgery as a viable treatment option, along with a list of its positive effects, which include an improvement or very often also a complete remission of the disease.

Over the past 30 years, the ingredients in our food have drastically changed. Contemporarily, we all tend to eat heavily processed food. How does it affect us? By the time our food reaches the center of the small intestine, it is completely digested biochemically. In the small intestine, numerous peptides are released that influence insulin production and activity. The function of these peptides varies depending on the part of the intestine they belong to, and their secretion depends on the type of food the intestine is fed with. In general, as the amount of complex nutrients in the distal part of the intestine decreases, the influence of natural peptides on insulin weakens. Thus, all bariatric procedures that shorten the path to the ileum (which is the distal part of the small intestine) minimize tissue resistance to insulin. This results in the activation of insulin-activating polypeptides. This is why metabolic surgery, especially resistance to mole interposition (by replacing the first with the distal part of the small intestine) is so effective in controlling diabetes. This correlation is often highlighted on surgical charts which help the doctors to evaluate how much impact an operation can have on the course of diabetes mellitus. Especially with the Duodenal Switch, Ileal Transposition and Transit Bipartition, experienced surgeons note a particularly strong anti-diabetic effect of these operations.