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Duodenal exclusion devices: promising tools in treating obesity and type 2 diabetes
  1. Bethany P Cummings
  1. Correspondence to Dr Bethany P Cummings, Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA; bpc68{at}cornell.edu

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The prevalence of obesity and type 2 diabetes is increasing worldwide at an alarming rate. As of 2008, the worldwide prevalence of type 2 diabetes was estimated to be approximately 9% of the global adult population.1 While pharmacotherapeutic options for the treatment of type 2 diabetes are expanding, patients suffering from type 2 diabetes continue to experience a significantly higher risk of developing comorbidities such as cardiovascular disease, kidney disease and cancer.2 Therefore, the development of new therapeutic modalities for the treatment of obesity and type 2 diabetes is crucial.

Bariatric surgery is currently considered the most effective therapeutic modality for the long-term treatment of obesity.3 Furthermore, certain bariatric procedures have been reported to result in relatively high rates of type 2 diabetes resolution. It is important to note that variation exists in the efficacy of different bariatric procedures to produce diabetes resolution. For example, gastric banding has been reported to result in diabetes resolution rates of around 55%; however, Roux en Y Gastric Bypass (RYGB) results in type 2 diabetes resolution rates of approximately 82% and biliopancreatic diversion can produce diabetes remission rates of 94%.3 Nevertheless, the underlying mechanisms responsible for the blood glucose lowering effects of bariatric surgery remain undefined, although many potential candidate mechanisms have been proposed.

RYGB is one of the more commonly performed clinical bariatric procedures and involves several major anatomic alterations, …

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