August 8, 2011
The sausage skin that cures diabetes: Device designed to beat obesity has surprising spin-off
An implanted sleeve that looks like a giant sausage skin is being used to tackle the most common form of diabetes.
The 2ft-long device, developed as an incision-less alternative to a type of weight-loss surgery known as a duodenal switch, can reverse the disease within weeks.
The duodenum is the name for the first 10 to 12in of the small intestine, which attaches to the stomach.
A duodenal switch is a keyhole procedure that involves making two incisions at the start and end of the duodenum. The lower part of the intestine is attached to the stomach, forming a new pathway.
Food then bypasses most of the duodenum, which limits absorption. Long-term risks include hernia and bowel obstruction.
The device, the EndoBarrier, is designed to have the same effects as surgery but is far safer. It is a plastic sleeve that lines the duodenum, meaning food can only be absorbed lower down the intestine.
The procedure is performed under anaesthetic in less than an hour. The sleeve – made from a thin plastic – is inserted via the mouth and passed into the digestive tract using a thin tube.
Once in place, a sprung titanium anchor prevents it slipping out. It is removed after a year.
During trials researchers found that in obese patients who also suffered diabetes, the disease went into remission.
Initially experts believed it was a result of weight loss – but many patients were able to stop taking their diabetes medication before they began to lose weight.
The discovery has led to clinical trials at three hospitals, which found the implant also seems to lower cholesterol levels and blood pressure.
Type 2 diabetes is a chronic condition caused by too much sugar in the blood. Initial symptoms include extreme thirst, tiredness and blurred vision.
Sufferers are five times more likely to suffer from heart disease and strokes and can suffer sight loss, nerve damage and kidney disease.
Ten per cent of all NHS spending – £9 billion a year – goes on treating diabetes, and £130 million is spent on tablets alone.
Type 2 diabetes occurs due to problems with the way the body handles insulin, a hormone that controls the amount of glucose in the blood.
When we eat, the digestive system breaks down food to release the nutrients from it. These nutrients, including glucose, enter your bloodstream.
Normally, insulin is produced by the pancreas to move glucose from the blood into the cells, where it is broken down to produce energy.
It is thought that type 2 diabetes is a result of the body being unable to produce enough insulin or because the cells in the body do not react properly to insulin.
Affecting 2.8 million Britons, poor diet, lack of exercise, carrying excess weight as well as a family history contribute to the development of the disease.
The condition is treated with drugs designed to increase insulin production or reduce insulin resistance, but these do not stop the progression of diabetes, and some can also have side effects such as nausea, weight gain or liver damage.
With the EndoBarrier, the duodenum is bypassed, altering the balance of hormones in the body leading to a reversal in diabetes symptoms.
‘Food passing through the intestine triggers the release of hormones in the body,’ says Dr John Mason, consultant gastroenterologist at Trafford Healthcare NHS Trust, who implanted the first EndoBarrier in the UK.
‘These hormones have different functions, including signalling that the pancreas gland should release insulin.’
Results from a new study at Musgrove Park Hospital, Taunton, Somerset, show that in 72 per cent of cases, diabetic patients went into remission after the EndoBarrier was fitted, and after a year all had no need for medication.
‘The operation is available only privately,’ says Dr Mason. ‘The NHS has yet to decide on whether it should be a treatment.’
The operation costs £8,000. One patient to benefit is Jason McCullen, 39, an IT consultant from Sale, Manchester.
He developed diabetes in 2009. He had the EndoBarrier implanted at Trafford Hospital, Manchester this year.
‘I didn’t feel any pain afterwards. My waist over the past three months has gone from 42in to 38in. And I don’t need medication.’