“You might say we should do bypass surgery earlier, because if you wait too long, the cells are gone and you can’t rescue them,” he says. “There is controversy about this approach, but perhaps it would be best to reduce the weight earlier, and skip the 20 years of toxicity from high blood sugar levels and the development of complications.
“The difference between the 84% of people whose diabetes disappeared after bypass surgery and the 16% who remained diabetic,” he points out, “was the length of time they had the disease.”
The Swedish Obese Subjects Study compared surgical versus nonsurgical interventions in 4,000 obese people and found that people in the surgical group not only had improved remission of diabetes, but also improved prevention of new diabetes. There is even evidence that bariatric surgery lowers long-term mortality.
No final answer yet
The final answer, or answers, will take some time. As recently as 2008, researchers at Joslin Diabetes Center published work demonstrating that insulin resistance in the liver alone could, in mice, cause the development of metabolic syndrome. The metabolic syndrome is a collection of conditions — high blood pressure, high cholesterol, glucose intolerance, and obesity — that is generally viewed as a precursor to diabetes.
The Joslin researchers tested their hypothesis by genetically engineering mice with no insulin receptors in their livers, mimicking insulin resistance in the organ. The mice developed many of the conditions of metabolic syndrome and, when fed a high-fat diet, they all developed coronary artery disease. The control animals with normal livers did not display these results, leading to the conclusion that if insulin uptake in the liver is compromised, the metabolic syndrome and, potentially, diabetes will result. The study did not address the possible cause of insulin resistance in the liver in humans, so it opens yet another line of investigation into the cause or causes of Type 2 diabetes.