Simple gut surgery may offer diabetes cure

BRITAIN: Diabetes could be cured or controlled with a simple gut operation, according to British doctors running trials of therapies for one of the UK’s biggest health problems.

Patients treated at King’s College Hospital and University College Hospital in London and City Hospital in Birmingham found their diabetes had disappeared or become much milder after the operations, which reduce the release of hormones by the gut into the blood.

The findings offer hope for about 4 million people in this country who have type 2 diabetes, which is linked to lifestyle factors such as obesity. Sufferers include the actor Tom Hanks.

The results of the trials suggest that gut surgery could improve thei r conditions - even without any weight loss.

Francesco Rubino, professor of metabolic surgery at King’s, said: ‘‘About 50 per cent of patients are diabetes-free after these procedures. The remaining people demonstrate big improvements of blood sugar control and can drastically reduce their dependence on insulin or other medication. In many patients, blood sugar levels go back to normal within days, long before declines in fat levels or weight.’’

Type 2 diabetes has become an epidemic, and the spiralling cost of treating it threatens to undermine the NHS. Treatment costs the NHS £10 billion a year - about 10 per cent of the total budget. If cases hit five million by 2025, as predicted, the figure will reach about 17 per cent.

Andrea Midmer, 59, a nurse, took part in the trial, in which a plastic liner or ‘‘endobarrier’’ was fitted into her stomach to stop the w alls of her upper gut coming into contact with the food she ate. ‘‘The effect was immediate,’’ said Midmer, who weighed 20 stone and was on insulin when the trial started. ‘‘I stopped feeling hungry, I ate much smaller meals and I lost 4 and a half stone. They had to take the endobarrier out recently as it is not licensed to be used for more than a year but I still halved my dose of insulin. If they offered it to me again, I would jump at it.’’

Such treatments stem from a new view of the causes of diabetes, a condition in which there is too much glucose in the blood. Historically, it was blamed on the pancreas not secreting enough insulin, the hormone that controls glucose levels - but Rubino and his colleagues believe the gut is the real key player.

The evidence for the new approach comes partly from patients who have had gastric bypasses or related procedures to help them lose weight. Surgeons found that many such patients were also cured of diabetes, even before losing much weight.

‘‘This has been known for decades but the mechanism is only just emerging,’’ said Rubino.

However, such procedures are invasive and risky, and also too expensive to be a mass solution - so quicker, cheaper methods, such as the process being tried out, are needed.

The endobarrier that Midmer used is one approach.

Another way, being tried by Bu Hayee, a gastroenterologist at King’s, involves putting a balloon-tipped probe down the throat and into the duodenum and then inflating the balloon with hot water to burn away some of the cells in the lining of the gut and reduce the hormones secreted when food is eaten.

Hayee has overseen the trials in which the endobarrier devices are inserted into the gut in a simple 20-minute procedure.

‘‘Patients who undergo it have seen marked improvement in diabetic symptoms,’’ said Rubino, who is a paid consultant to some firms marketing such devices.