Today, type 2 diabetes mellitus is no longer a death sentence!

Type 2 diabetes mellitus is a metabolic disorder (a nutritional disturbance) characterized by chronic hyperglycemia (increased blood sugar levels) which develops as the result of disrupted interaction of insulin with tissue cells.

The disease has a number of life-threatening complications:

• Angiopathy. Diabetes mellitus primarily causes vessel damage. Blood vessel walls become increasingly less permeable to nutrients, and vessel lumen decreases. All tissues of the body suffer from shortage of oxygen and other vital substances.
• Nephropathy. Kidneys of a person affected by diabetes mellitus gradually lose the ability to perform their functions, and a chronic insufficiency develops.
• Retinopathy is a retina impairment which leads to hemmorhage in the ocular fundus and retina detachment. This results in complete loss of eyesight. Most frequently, retinopathy is observed in patients affected by type 2 diabetes mellitus. For a person with a record of over 20 years of diabetes, the level of risk of retinopathy approaches 100%.
• Polyneuropathy. This disorder is marked by loss of sensitivity of limbs to pain and heat. The disorder most predominantly develops as a “gloves and socks” syndrome, that is, it manifests itself in the upper and lower extremities. The first symptoms are numbness and a burning sensation in the limbs, they become more pronounced during the night.
• Diabetic foot. This is a complication where perforated ulcers, purulent abscesses and necrotic (dead) regions start to appear on the feet and lower limbs of a person affected by diabetes mellitus.

During the last decades, the prevalence of diabetes mellitus (DM) has taken epidemic proportions: whereas at the close of the last century the total number of persons affected by DM did not exceed 130 million, presently their number is above 300 million, and by 2030 it may go up one-and-a-half times and amount to 438 million persons, according to a forecast made by the International Diabetes Federation, mainly owing to those afflicted by type 2 DM who account for over 90% of the total number of patients. Presently, a tendency is noted of both growing prevalence of type 2 DM and development of the pathology at a younger age. This is associated with general urbanization, growing prevalence of obesity and sedentary lifestyle.

Pharmaceutical therapy (administration of antihyperglycemic drugs, and, in certain cases, of insulin) does not offer a permanent cure of the disease, since this is only substitution treatment.

Currently, a surgical technique of treatment of the pathology is already known. What is more, tremendous effectiveness of the technique has been proven. Surgical treatment of type 2 diabetes mellitus makes it possible to completely cure the pathology and stop the administration of blood glucose lowering drugs. This family of surgical technique belongs to metabolic surgery.

Metabolic surgery is a surgical intervention technique aimed at the recovery of a function or at the normalization of the metabolic system activity.

Clinical trials performed over the last ten years allow to conclude that the most effective surgical intervention is gastric bypass surgery (the so-called Mini-Gastric Bypass).

It was found out that these operations result in the recovery of 90-98 % cases of type 2 DM. The above fact was the staging ground for research of the possibility to use metabolic surgery procedures for definitive treatment of type 2 diabetes mellitus not only in patients affected by obesity, but also in persons with normal body weight or with moderate body mass excess (BMI of up to 30).

What is the purpose of the operation?

• Blood sugar status returns to norm as soon as a few days after the operation.
• Over several years, the patient's weight approaches satisfactory values (e.g., with a height of 180 cm, average body weight would be 80 to 85 kg).
• Smaller stomach volume results in faster satiation.
• Food travels from stomach directly to the ileum. bypassing the jejunum.
• Patients stop making insulin injections in 98% of cases, and stop the administration of blood glucose lowering drugs in 85% of cases.

Why should food be transported to ileum?

L-cells of the ileum's mucosal lining produce glucagonlike peptide-1. The less the food that enters ileum is processed by digestive juices, and the sooner it reaches ileum the more pronounced stimulation of L-cells would be.

L-cell stimulation results in:

• lowered appetite;
• lowered evacuation of gastric material;
• increased growth rate of cells that produce insulin;
• increased levels of insulin;
• decreased apoptosis of B-cells, that is, the rate of self-destruction of insulting-producing cells; decreased secretion of glucagon;
• increased insulin sensitivity;
• activation of the heart cell protection system.

We use laparoscopic surgical procedure!

At our Health Care Center, the operation is performed with the use of modern minimally invasive methods:

• maximum patient comfort during the early postoperative period;
• minimal duration of stay at the inpatient facilities;
• reduced risk of infections and postoperative problems;
• aesthetic benefit.

What are the indications to operative therapy?

Persons affected by diabetes mellitus do not complain at early stages of the disorder, and are reluctant to undergo the operation.

A surgical procedure, even a planned one, still involves some risks, thus we will not recommend the therapy without a solid indicative base.

• Patients aged 30 to 65.
• Type 2 diabetes mellitus duration of no more than 10 years, treatment by oral pharmaceuticals.
• Type 2 diabetes mellitus duration of no more than 10 years, insulin dependency duration of no less 7 years, brittle status (HbA1c > 8.0%)
• Patients affected by diabetes mellitus that have sufficient pancreatic gland reserve (С-peptide >= 1 ng/ml, mandatory glucagon test).
• negative pancreatic gland β-cell antigen (ICA, IA-2, GAD 65 K) analysis result.
• Patients with a high body mass index (BMI>30 kg/m2) aggraveted by type 2 diabetes mellitus.

Clinical trials give pause for reflexion! 85% is a HIGH percentage!

Gastric bypass surgical procedures have a history of more than 50 years. The positive effect of the metabolic surgery on the progress of diabetes mellitus was confirmed by numerous clinical trials that studied long-term results of operations. It was proven that complete cure of diabetes mellitus was noted in 85% of patients that underwent gastric bypass surgery. These patients were able to forgo any medicinal therapy completely. In the remaining 2 to 15% of patients, significant positive dynamics was noted in the form of reduced doses of anti-diabetic drugs. Long-term result studies revealed that morbidity associated with diabetes mellitus complications within the group that underwent operative therapy was 92% lower than in the group which was subjected to conservative therapy.

Clinical trials were also performed to study the effect of metabolic surgery on the progress of type 2 diabetes mellitus in patients with normal body weight and a moderate body mass excess (BMI of up to 30). The research confirmed the above positive results -- 90% of cured type 2 diabetes mellitus cases in this category of patients and a positive dynamics in the remaining 10%.

If body mass index of the patient affected by diabetes is 35 and above, the operation is definitely recommended.

On the other hand, in patients with a normal or moderately increased body weight, an assessment of surgical risks and the positive effects that may be achieved by treating diabetes should be carried out. Considering the fact that even a proper conservative therapy is not a reliable way to prevent diabetic complications (diabetic retinopathy, nefropathy, neuropaty and angiopathy invloving a broad spectrum of severe aftereffects), the application of metabolic surgery may prove to be a promising therapeutic method even in this latter group of type 2 diabetes mellitus patients.

Presently, it is believed that the operation is recommended to a type 2 diabetes mellitus patient with a BMI of less than 35 in cases when is its impossible to achieve compensation of the disease by oral medicinal products, and insulin must be prescribed. Since the main cause of type 2 diabetes mellitus is the patient's insulin resistance and not deficit of insulin, this administration of additional quantities of exogenous insulin is a purely least-evil solution which in no way targets the cause of the disorder. On the other hand, the operation lifts the insulin resistance and offers concurrent normalization of the glycemic status. The third group are shunting operations performed on patients with diabetes mellitus that have a BMI of 23 to 35 and are not administered insulin. This group of patients presently acts as the trial team. There are patients with normal or slightly increased weight that wish to solve their diabetes problem decisively. These patients take part in the studies. The obtained results are very promising -- in this group, a stable clinico-laboratorial remission of diabetes is achieved in all the patients.