Article preview reprinted from IN VIVO - January 2009
The notion of how Roux-en-Y achieves weight loss and reverses diabetes is changing. Francesco Rubino, MD, chief of gastrointestinal metabolic surgery at Cornell University's Weill Cornell Medical College is at the forefront of diabetes surgery. Rubino's diabetes surgery program aims to tease out the mechanisms by which gastric bypass reverses diabetes. Here, an interview with Dr. Rubino.
A Mechanistic Look at Diabetes Surgery
Article preview reprinted from IN VIVO - January 2009
Francesco Rubino, MD, chief of metabolic surgery at Weill Cornell Medical College is leading the charge for diabetes surgery. He has published extensively on his theories concerning the effect on diabetes of bypassing the intestine, and, independently of weight loss, the potential mechanisms of action that lead to the reversal of type 2 diabetes. Rubino isn't alone: bariatric surgeons, gastroenterologists and endocrinologists around the world are also studying the mechanisms of diabetes surgery, but Rubino attracted attention to the field in September 2008, when he spearheaded the First World Congress on Interventional Therapies for Type 2 Diabetes, sponsored by Weill Cornell Medical College and New York-Presbyterian Hospital. The first conference of its kind drew 1,000 people from all walks of diabetes care internationally, a measure of hot interest in diabetes intervention. IN VIVO spoke to Dr. Rubino about this emerging field.
Q: In Vivo: Please tell us about the diabetes surgery division at Weill Cornell-NY Presbyterian Hospital.
Francesco Rubino: It is a new section of the department of surgery dedicated to the treatment of patients with diabetes. Of course, many morbidly obese patients also have diabetes and now they represent the majority of patients treated in our program. However, we also run clinical trials to investigate the safety and efficacy of surgical treatments for diabetes in patients who are not necessarily morbidly obese.
Q: Would you explain that distinction?
Rubino: A typical bariatric surgery program takes care of patients with a BMI of 40 or greater, with the primary aim of achieving significant weight loss; diabetes control is a consequent clinical benefit, but it is not the primary concern of these programs. Our program is instead predisposed to specifically treat patients with diabetes. This is an important difference that has several implications. First, unlike in conventional bariatric surgery programs, my own personal commitment, and that of my co-workers, is to consider the control of diabetes as a primary objective of our work. Consistent with this goal is also the fact that we are going to systematically include an endocrinologist/diabetologist in the evaluation of each patient that comes to our program. Diabetes is the number one outcome that we are looking to control, rather than body weight per se. It is a big shift in the way we consider bariatric surgery; that's why we call it metabolic surgery. Bariatric surgery improves a number of other co-morbidities, but everything revolves around excess body weight loss. However, it's not the excess body weight that kills patients. It is the metabolic alterations associated with it: diabetes, hypertension, hyperlipidemia, and so forth. Surgery can improve all of these metabolic conditions and that's what is going to reduce mortality and improve survival in these patients.
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