Surgical solutions

Surgical intervention to help manage or even reverse type 2 diabetes has become well established over the last two decades. In the first module in EASD e-Learning’s latest course, ‘Metabolic surgery’, Professor Carel Le Roux examines the underlying mechanisms that make this much talked-about treatment so effective.

There are various mechanisms by which metabolic surgery can benefit physiological processes of particular significance in type 2 diabetes and obesity. Of these, the one most closely associated with metabolic surgery in people’s minds is weight loss. But as Carel’s module clearly demonstrates, the story is much more complex – the potential benefits more nuanced and richer.

“I think what we now can say is that the dominant mechanism is weight loss,” says Carel. “But why do people have weight loss after metabolic surgery? The first thing we hear from patients is that after the operations they suddenly feel less hungry and they feel more satisfied when they eat a smaller amount of food. To understand why this happens, we have to delve a little bit deeper and understand the signals from the gut to the brain.”

Carel, who is Professor of Metabolic Medicine at Ulster University and Chair of Experimental Pathology at University College Dublin, specialises in managing patients undergoing bariatric surgery and pharmacotherapy, to reduce complication risks and make the most of the health benefits of weight loss. His research activity focuses on the mechanisms of bariatric surgery, the relationship between the gut and the brain and how signals between them can be optimised, and, primarily, increased mortality and morbidity associated with obesity and diabetes.

From changes to food preferences to insulin secretion, GLP-1 and inflammation to gut microbiota, his module is a compelling examination of the topic and a must-read for anyone needing to advise their patients on the shorter and longer term effects of surgery for obese people with type 2 diabetes.

Click here to enroll on Professor Le Roux’s module, Mechanisms of metabolic surgery. Don’t miss Professor Le Roux’s contribution to our podcast series, The patient who changed the way I think about diabetes, launching on Horizons on Thursday.