Diabetes surgery offers hope

Posted on Monday, September 10th, 2012

Sitting behind the desk of his real estate office on Houston’s West Side, 53-year-old Ignacio Osorio does not look like someone who was seriously ill just two months earlier.

First diagnosed with Type 2 diabetes almost 15 years ago, Osorio relied on five medications in an attempt to keep his blood sugar level in check. Instead, it raged like a roller coaster — all the while his legs ached and his vision was blurred.

Osorio’s interest was piqued when he saw a report by Christi Myers, the award-winning health reporter for Houston’s KTRK Channel 13, about patients being recruited by UT Physicians for a study on a promising surgical treatment for Type 2 diabetes.

“That night I went online and sent an email telling the folks at the study that I was interested in signing up,” says Osorio, who manages a real estate firm with 1,200 agents. “I later saw a battery of specialists and got a lot of blood work done in order to qualify for the study.”

‘110 percent better’

Osorio is among millions of Americans who have been diagnosed with Type 2 diabetes, which stems from problems associated with a hormone – insulin – that regulates blood sugar levels. Diabetes can lead to a host of health problems that can result in blindness, amputation and even death.

UT Physicians are evaluating a “band aid” surgical procedure for Type 2 diabetes that shrinks the size of the patient’s stomach and repositions a 5-foot section of the small intestine.

The procedure, which is known as an ileal transposition with sleeve gastrectomy, has been associated with encouraging results in studies. The physicians report they are the first to conduct a comparison of the operation with the traditional management of Type 2 diabetes, which can include medications, lifestyle changes, and diet.

On May 14, Osorio was admitted to Memorial Hermann-Texas Medical Center and operated on by UT Physicians surgeons and study investigators Brad Snyder, M.D., and Erik Wilson, M.D. Osorio was back at work a week later.

“Everything is back to normal. I feel a 110 percent better,” Osorio says.

In fact, Osorio and his wife, Adriana, recently returned from a Caribbean vacation at the tiny islands of Vieques and Culebra, where the father of four rode horses and swam in the sea.

Osorio says he was sore following surgery and limits what he eats. Because the procedure involved shrinking his stomach, Osorio sticks to small quantities of soup, salad and soft food. He avoids carbonated beverages and sweets. “I have the support of my wife who watches what I eat like a hawk,” Osorio says.

Seeking answers

While Type 2 diabetes is often associated with being overweight, that was not the case with Osorio, who barely met the study’s weight requirements. Unlike traditional bariatric surgery, ileal transposition and sleeve gastrectomy is being evaluated on those who do not have a life threatening weight problem and would not qualify for traditional weight loss surgery. This study is restricted to people who have a body mass index (BMI) of 25 to 34, are between 21 and 55 years of age and are being treated for Type 2 diabetes.

The procedure is similar to a treatment for morbid obesity—bariatric surgery, which can involve surgery on the stomach and intestines. Research shows that oftentimes Type 2 diabetes improves or resolves in morbidly obese patients following gastric bypass surgery.

“We are beginning to understand better why people with morbid obesity and Type 2 diabetes experience this enhancement after surgery,” says Dr. Snyder, the study’s principal investigator.

He says it could be a combination of the different metabolism of food, the improvement of insulin action, and the improvement in insulin secretion. “This research will help us find some answers and could lead to future treatments,” Dr. Snyder says.

The ileum is the final section of the small intestine, and it is transposed to be closer to the stomach. Studies have shown that when placing the ileum closer to the stomach, food from the stomach enters the ileum quickly and hormones that help regulate diabetes are more easily stimulated.

If successful, the next step could involve a large clinical trial. “Our goal is to gather this primary data in a small group to show the safety and likely significance as well,” Dr. Snyder says.

Meantime, Osorio says he is feeling much better. “My average blood sugar level was 175 to 200 mg/dl prior to surgery. Now it’s 95 to 110 mg/dl.”

To learn more about the eligibility requirements for the study, contact Anna Tenorio, 713.486.1363. The cost of the operation is usually not covered by health insurance. Information on the clinical trial protocol can be found here.

—Rob Cahill, Office of Advancement, Media Relations

The medical group practice of The University of Texas Medical School at Houston, UT Physicians offers the most advanced technologies with a personalized touch from its flagship location in the Texas Medical Center and at a growing number of clinics throughout the greater Houston area.

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