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A Mechanistic Look at Diabetes Surgery

Executive Summary

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.

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GI Dynamics: In Metabolic Disease a Device Might Trump Drugs

It's not often that a company in the medical device industry, where most new products offer incremental innovation, has a chance to change the world. Start-up GI Dynamics does, though. Shooting for a non-invasive device that would replicate some of the benefits of the invasive Roux-en-Y gastric bypass surgery in obesity, it discovered that an endoscopically delivered implant appears to be extremely effective in type 2 diabetes, as is the predicate gastric bypass. Simple and non-invasive, the technology is potentially disruptive by reversing the disease, not just managing its symptoms. (See also the sidebar to this article: "A Mechanistic Look at Diabetes Surgery: An Interview with Francesco Rubino." )

The Other Diabetes: An Interventional Market Emerges

The American Society for Bariatric Surgery recently changed its name to the American Society for Bariatric and Metabolic Surgery, in recognition of the link between obesity and Type 2 diabetes. Published data has long shown that in many cases, when morbidly obese patients with Type 2 diabetes lose weight--through gastric bypass surgery or other means--their glucose levels return to normal. That's old news. But something new is happening: bariatric surgeons and companies with implantable devices originally intended for weight loss are publishing data that shows a reversal in Type 2 diabetes, sometimes independently of a reduction in weight, by some other mechanisms as yet unproven. In September, the "First World Congress On Interventional Therapies for Type 2 Diabetes" convened the clinical community and industry to discuss new treatment strategies.

MetaCure Ushers in a New Era in Interventional Diabetes

Welcome to the new world of interventional diabetes. Based on new data, institutions offering gastric bypass surgeries for weight loss are now recasting them as treatments for type 2 diabetes. This is a dramatic change in perspective within the drug-oriented diabetology world. Now MetaCure hopes to take that interventional notion a step further, with a minimally-invasive and reversible therapy based on electrical stimulation applied to the stomach.

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