0:00:08 > 0:00:10Hello, I'm Elaine Dunkley and on this week's Inside Out, we ask,
0:00:11 > 0:00:13can the NHS survived diabetes?
0:00:13 > 0:00:16We investigate the epidemic of Type 2 diabetes and its impact
0:00:16 > 0:00:22on patients and NHS financing.
0:00:22 > 0:00:25We'll be speaking to a leading scientist who says the most common
0:00:25 > 0:00:30form of the disease can be reversed without drugs.
0:00:30 > 0:00:32And we'll be asking, could the NHS save millions
0:00:32 > 0:00:42by offering more bariatric surgery to Type 2 diabetes patients?
0:00:48 > 0:00:52Around 4.5 million people in the UK now have diabetes and that number
0:00:52 > 0:00:55is continuing to rise.
0:00:55 > 0:00:58Most of them have Type 2, which is usually linked to lifestyle
0:00:58 > 0:01:03and is largely preventable yet diabetic care already costs the NHS
0:01:03 > 0:01:07?10 billion a year, 10% of its entire budget.
0:01:07 > 0:01:11New figures seen by the BBC show those costs are likely to spiral
0:01:11 > 0:01:14if obesity continues to rise.
0:01:14 > 0:01:17So, can the NHS survived diabetes?
0:01:17 > 0:01:27Our health correspondent, Dominic Hughes, reports.
0:01:29 > 0:01:35Today, I d like to invite you to a shoe-shop with a difference.
0:01:35 > 0:01:40So, what we ve got here are 140 shoes and they represent the 140
0:01:40 > 0:01:43amputations that take place in England every week,
0:01:43 > 0:01:49due to diabetes.
0:01:49 > 0:01:50Cor.
0:01:50 > 0:02:00Quite shocking.
0:02:04 > 0:02:06We set up this shoe shop, to show just how serious
0:02:06 > 0:02:08Type 2 diabetes can be.
0:02:08 > 0:02:11It s really sad.
0:02:11 > 0:02:12Has that shocked you?
0:02:12 > 0:02:21Yeah.
0:02:21 > 0:02:23Most diabetics have Type 2.
0:02:23 > 0:02:27Where you come from and your family history can increase your risk.
0:02:27 > 0:02:31But doctors say most of it is down to obesity.
0:02:31 > 0:02:35Now, new data given exclusively to the BBC by Public Health England
0:02:35 > 0:02:40estimates there will be an extra 250,000 people with Type 2 diabetes
0:02:40 > 0:02:44by 2035, if we continue to get fatter.
0:02:44 > 0:02:47It is not just amputations.
0:02:47 > 0:02:51Diabetics are at greater risk of kidney failure,
0:02:51 > 0:02:53blindness and even premature death.
0:02:53 > 0:02:57The NHS is spending ?10 billion a year on diabetic care.
0:02:57 > 0:03:01That is 10% of its entire budget.
0:03:01 > 0:03:04As things stand, we are certainly looking at a crisis in diabetes
0:03:04 > 0:03:06which threatens to bankrupt the NHS, if we continue with
0:03:06 > 0:03:11these current trends.
0:03:11 > 0:03:17One of our shoes belongs to Steven Woodman.
0:03:17 > 0:03:21We caught up with him as he arrived at the Royal Shrewsbury Hospital for
0:03:21 > 0:03:27an appointment with his podiatrist.
0:03:27 > 0:03:30Like 90% of diabetics, Steven has the Type 2 version,
0:03:30 > 0:03:34which is linked to lifestyle and, so, largely preventable.
0:03:34 > 0:03:39But diagnosed as a young man, he ignored his GP s advice.
0:03:39 > 0:03:42I was in denial.
0:03:42 > 0:03:50I never took it that seriously, so I carried on eating,
0:03:50 > 0:03:53going to the pub, doing things people of my age did.
0:03:53 > 0:04:00Of course now, I know different.
0:04:00 > 0:04:02Like many diabetics, Steven developed an ulcer
0:04:02 > 0:04:04on his toe.
0:04:04 > 0:04:07Look away now if you are squeamish.
0:04:07 > 0:04:10The ulcer would not heal and, in the end, he had
0:04:10 > 0:04:11to have his toe amputated.
0:04:11 > 0:04:17He has lost two more since then.
0:04:17 > 0:04:22My surgeon did say to me, when he was taking my third toe off,
0:04:22 > 0:04:25"It's only a matter of time before you lose that one.
0:04:25 > 0:04:31"It's inevitable that will go the same way."
0:04:31 > 0:04:34Patients with Type 2 diabetes are not just losing their toes.
0:04:34 > 0:04:37Some have had to have a foot amputated or even a lower leg.
0:04:37 > 0:04:40It is life changing and very expensive.
0:04:40 > 0:04:43It is approximately ?20,000 for first six months,
0:04:43 > 0:04:49following amputation.
0:04:49 > 0:04:50There is the limb fitting.
0:04:50 > 0:04:55Even a basic prosthesis costs thousands of pounds.
0:04:55 > 0:05:00All of those aspects mean it is a very expensive
0:05:00 > 0:05:06process for the state.
0:05:06 > 0:05:09Nick Hex is the health economist who worked out the current
0:05:09 > 0:05:14cost of diabetes care - that ?10 billion figure.
0:05:14 > 0:05:20Most of that is spent on complications.
0:05:20 > 0:05:23Foot ulcers and amputations cost nearly ?1 billion a year.
0:05:23 > 0:05:25Kidney failure is not far behind.
0:05:25 > 0:05:32Then, there is sight loss and nerve damage.
0:05:32 > 0:05:35But the biggest cost of all is for heart attacks and strokes.
0:05:35 > 0:05:37With both obesity and Type 2 diabetes affecting more and more
0:05:37 > 0:05:41of us, costs for diabetic care are expected to increase
0:05:41 > 0:05:48to ?17 billion by 2035.
0:05:48 > 0:05:50There is a fixed amount of money for the NHS,
0:05:50 > 0:05:53so clearly, if one disease area, like diabetes, is taking up more
0:05:53 > 0:05:57considerable amount of that cost, then there is less money to spend
0:05:57 > 0:06:03on cancer, so it is really important that policy makers think
0:06:03 > 0:06:08about the ways costs can be mitigated over next few years,
0:06:08 > 0:06:12because there will not be enough to go round.
0:06:12 > 0:06:18Just taking all measures.
0:06:18 > 0:06:20Back at the Royal Shrewsbury Hospital, Steven is
0:06:20 > 0:06:22getting his feet measured.
0:06:22 > 0:06:27Losing three toes means he has to have specially-made shoes.
0:06:27 > 0:06:29They do not come cheap.
0:06:29 > 0:06:35Just out of interest, how much do they cost?
0:06:35 > 0:06:37?400-?500.
0:06:37 > 0:06:41Wow, really?
0:06:41 > 0:06:47We are facing a diabetic epidemic and need to find ways of preventing
0:06:47 > 0:06:50those patients from reaching surgeons, because the cost to the
0:06:50 > 0:07:00patient and the NHS is skyrocketing.
0:07:00 > 0:07:03A new problem is expected to put even more financial
0:07:03 > 0:07:08pressure on the NHS.
0:07:08 > 0:07:1016-year-old Aisha is one of a small, but growing, number of children
0:07:11 > 0:07:16with Type 2 diabetes.
0:07:16 > 0:07:20I developed T2D by having a sweet tooth mostly.
0:07:20 > 0:07:23I used to try out every new sweet in the store.
0:07:23 > 0:07:27I used to drink quite a lot of sugary drinks.
0:07:27 > 0:07:33When I was taken to the hospital, it hit me then, because I started
0:07:33 > 0:07:40crying and it was shock.
0:07:40 > 0:07:44Aisha now has to rely on medicine to control her condition.
0:07:44 > 0:07:48But she has managed to lose a stone in weight and those fizzy drinks
0:07:48 > 0:07:52are a thing of the past.
0:07:52 > 0:07:58It's been really hard at times, but you can only have health once
0:07:58 > 0:07:59and you can't buy your health.
0:07:59 > 0:08:07You have to keep changing your diet plan, to keep fit and healthy.
0:08:07 > 0:08:10New research shows the number of children like Aisha with Type 2
0:08:10 > 0:08:13diabetes has nearly doubled in the last ten years.
0:08:13 > 0:08:22And they are likely to develop complications much earlier.
0:08:22 > 0:08:27People who are getting T2D when they're 15 or 16 are likely
0:08:27 > 0:08:33to have significant problems maybe at the age of 35, 36,
0:08:33 > 0:08:35and that's really much younger than you d expect.
0:08:35 > 0:08:38These are things like renal failure and heart attacks and strokes
0:08:38 > 0:08:42and it is going to have a huge impact for them.
0:08:42 > 0:08:44Ultimately, tackling the rise in Type 2 diabetes will depend
0:08:44 > 0:08:50on reducing our waistlines.
0:08:50 > 0:08:53I believe we're facing a crisis and we really need concerted action
0:08:53 > 0:08:56right across society, for us to fund more research,
0:08:56 > 0:08:59provide best possible care and, crucially, prevent so many cases
0:08:59 > 0:09:09of Type 2 in future.
0:09:14 > 0:09:18Steven's diabetes has stabilised, but it is too late to save his job.
0:09:18 > 0:09:21The toe amputations have left him unsteady on his feet and he has been
0:09:21 > 0:09:24told by his employer that he is no longer fit for work.
0:09:24 > 0:09:25Given everything you have been through, Steve,
0:09:25 > 0:09:28what would your advice be to people being diagnosed now with T2D?
0:09:28 > 0:09:31For God's sake, take it seriously.
0:09:31 > 0:09:38Don't make the mistake I did.
0:09:38 > 0:09:41It's the biggest regret I've ever made in my entire life.
0:09:41 > 0:09:42It's a dreadful nasty disease.
0:09:42 > 0:09:44It takes no prisoners.
0:09:44 > 0:09:51It's a terrible thing.
0:09:51 > 0:09:53It's widely believed if you have the most
0:09:53 > 0:09:56commonest form of diabetes, Type 2, you will have it for life.
0:09:56 > 0:09:59But a leading scientist from Newcastle is challenging
0:09:59 > 0:10:02that orthodox view.
0:10:02 > 0:10:05He says the disease can be reversed without drugs.
0:10:05 > 0:10:07So, could his radical approach be the answer to the
0:10:07 > 0:10:09diabetes time bomb?
0:10:09 > 0:10:16Chris Jackson reports from the North East.
0:10:16 > 0:10:19He thinks his diabetes could kill him.
0:10:19 > 0:10:20How do you feel at the minute?
0:10:20 > 0:10:22I haven't really got any energy.
0:10:22 > 0:10:24I mean, I easily get out of breath.
0:10:24 > 0:10:27What are you actually worried about with this?
0:10:27 > 0:10:29I'm concerned about having a stroke, having a heart attack,
0:10:29 > 0:10:32kidney failure, and different types of things that can happen.
0:10:32 > 0:10:34It's frightening when you think about it.
0:10:34 > 0:10:37But, a few miles away, a world-renowned professor believes
0:10:37 > 0:10:43he's found a solution that could help Ed and many like him.
0:10:43 > 0:10:45Type 2 diabetes is reversible for most people, certainly
0:10:45 > 0:10:49in the first ten years.
0:10:49 > 0:10:52Roy Taylor's claim has stunned the medical world.
0:10:52 > 0:10:56Are we potentially on the cusp of a revolution here?
0:10:56 > 0:10:58I believe we are.
0:10:58 > 0:11:01If he's right, Professor Taylor will help hundreds of thousands
0:11:01 > 0:11:04of diabetes patients free themselves of the condition
0:11:04 > 0:11:09and save the NHS billions of pounds.
0:11:09 > 0:11:11And it's all a question of what you eat.
0:11:11 > 0:11:13Or, rather, what you don't.
0:11:13 > 0:11:15Professor Taylor's team at Newcastle University asked
0:11:15 > 0:11:20volunteers with Type 2 diabetes to go on a very low-calorie diet,
0:11:20 > 0:11:24designed to melt away fat from key parts of the body.
0:11:24 > 0:11:30Our hypothesis was that Type 2 diabetes was typified by too
0:11:30 > 0:11:31much fat in the liver.
0:11:31 > 0:11:34And if we got rid of that, things might return to normal.
0:11:34 > 0:11:37We look at this organ, that's the liver.
0:11:37 > 0:11:41The level of fat is, in fact, 36%, which is extremely high.
0:11:41 > 0:11:46But after eight weeks of this diet, just look at this, 2% liver fat.
0:11:46 > 0:11:47It has gone black.
0:11:47 > 0:11:48We're down here.
0:11:48 > 0:11:51So that's a dramatic change.
0:11:51 > 0:11:52An amazing difference.
0:11:52 > 0:11:55This is the same person but you might say reborn.
0:11:55 > 0:11:58Fat levels also fell in the pancreas, the organ that
0:11:58 > 0:11:59controls blood sugar levels.
0:11:59 > 0:12:02The most exciting thing is the function.
0:12:02 > 0:12:05Type 2 diabetes, after one week, a bit of a response.
0:12:05 > 0:12:09Four weeks, eight weeks, it had gone back to normal.
0:12:09 > 0:12:13The function's been restored, and that is a magic thing.
0:12:13 > 0:12:16With insulin production back to normal, the patient's Type 2
0:12:16 > 0:12:18diabetes went into remission.
0:12:18 > 0:12:21How excited are you about this?
0:12:21 > 0:12:25Extremely excited because this is sorting out a condition that's
0:12:25 > 0:12:27caused puzzlement for a long time.
0:12:27 > 0:12:30Now Professor Taylor is undertaking a much bigger study backed
0:12:30 > 0:12:33by a research grant of more than ?2 million, with volunteers
0:12:33 > 0:12:37from the North East.
0:12:37 > 0:12:41The large study will actually find out how many people are likely to be
0:12:41 > 0:12:44able to follow this diet in routine general practice, and will diabetes
0:12:44 > 0:12:52stay away for the two-year follow-up period of the study?
0:12:52 > 0:12:55So how has diabetes actually changed your life?
0:12:55 > 0:12:57What do you have to do now?
0:12:57 > 0:13:01That's basically all the medication I've got to take, you know?
0:13:01 > 0:13:03But Ed's not waiting around for the results.
0:13:03 > 0:13:07He's been fighting his Type 2 for years.
0:13:07 > 0:13:10Now, in line with Professor Taylor's model, he's decided to restrict
0:13:10 > 0:13:15himself to 800 calories a day for eight weeks.
0:13:15 > 0:13:17What can't you touch in this now?
0:13:17 > 0:13:19Well, that's one.
0:13:19 > 0:13:20Oh, right, the spreads.
0:13:20 > 0:13:23Some cheesy bits in there.
0:13:23 > 0:13:25Yes, if it's processed meats, I don't think you're supposed
0:13:25 > 0:13:26to have them as well.
0:13:26 > 0:13:28This is going to be difficult, isn't it?
0:13:28 > 0:13:31Because the rest of the family and going to have to keep
0:13:31 > 0:13:32on eating normally.
0:13:32 > 0:13:35So what's to stop you coming in here and having a raid?
0:13:35 > 0:13:36Nothing, really.
0:13:36 > 0:13:38The temptation's aways there.
0:13:38 > 0:13:41800 calories, that's not a lot, is it?
0:13:41 > 0:13:46The normal calorie intake, I think, for a man is around 2,500.
0:13:46 > 0:13:48Where do you fit in on that?
0:13:48 > 0:13:49Me?
0:13:49 > 0:13:50Yeah.
0:13:50 > 0:13:53I would possibly say into the 3,500 type of thing, you know?
0:13:53 > 0:13:54We're all rooting for you.
0:13:54 > 0:13:55Great.
0:13:55 > 0:13:56It starts now.
0:13:56 > 0:14:00It does.
0:14:00 > 0:14:03Ed's undertaking this radical diet with the backing of his GP.
0:14:03 > 0:14:06Have you actually noticed an increase in Type 2 diabetes?
0:14:06 > 0:14:07I've been here a long time.
0:14:07 > 0:14:11When I first came, we had about 40 patients who were diabetic.
0:14:11 > 0:14:12Now we've got nearly 300.
0:14:12 > 0:14:15I mean, it's a huge increase.
0:14:15 > 0:14:18Mike's surgery has so many diabetes patients, it has a nurse
0:14:18 > 0:14:20devoted to their care.
0:14:20 > 0:14:24Today, she's giving Ed his annual review.
0:14:24 > 0:14:29Do you want to step on the scales for me?
0:14:29 > 0:14:32126.
0:14:32 > 0:14:34Which is 1,912.
0:14:34 > 0:14:36We need to do a waist measurement.
0:14:36 > 0:14:38I'll put those there.
0:14:38 > 0:14:43144 centimetres, which is 57 inches.
0:14:43 > 0:14:4457 inches?
0:14:44 > 0:14:46Not quite Marilyn Monroe.
0:14:46 > 0:14:48Have you worked out a plan?
0:14:48 > 0:14:49With your food?
0:14:49 > 0:14:50Yeah, sort of.
0:14:50 > 0:14:51Write down the foods that you like.
0:14:51 > 0:14:54Make a plan and sit down with the family and it's easier,
0:14:54 > 0:14:57I think.
0:14:57 > 0:15:00He's one of more than 200,000 people in the North East
0:15:00 > 0:15:01and Cumbria with diabetes.
0:15:01 > 0:15:05That's more than 7% of the adult population.
0:15:05 > 0:15:07And, in little more than a decade, it's expected to rise
0:15:07 > 0:15:14to 300,000, more than 9%.
0:15:14 > 0:15:16In Cumbria, there's a different approach.
0:15:16 > 0:15:21Here, the belief is that, typically, diabetes is a lifelong condition.
0:15:21 > 0:15:24So the emphasis is on education to reduce the risks
0:15:24 > 0:15:27rather than eradication.
0:15:27 > 0:15:30What are the long-term effects for your health?
0:15:30 > 0:15:33We've got nerve damage, we've got eyes, trouble
0:15:33 > 0:15:36with the kidneys and trouble with the heart.
0:15:36 > 0:15:38The course is largely aimed at people with newly
0:15:38 > 0:15:42diagnosed Type 2 diabetes.
0:15:42 > 0:15:45It provides an opportunity both to understand the basics,
0:15:45 > 0:15:48to get to grips with the basics, but also to share stories,
0:15:48 > 0:15:52to ask questions in a safe environment.
0:15:52 > 0:15:59For people with Type 2 diabetes, the risk is increased.
0:15:59 > 0:16:09Here, it's all about behaviour, not just calories.
0:16:10 > 0:16:12Back in Newcastle, three weeks have gone by and it's
0:16:12 > 0:16:15so far, so good for Ed.
0:16:15 > 0:16:17Well, I'm starving.
0:16:17 > 0:16:21A chicken stir-fry, so it's all healthy.
0:16:21 > 0:16:22Fabulous.
0:16:22 > 0:16:25Thank you very much indeed.
0:16:25 > 0:16:27What difference has it made so far?
0:16:27 > 0:16:29I've lost four inches off my waist.
0:16:29 > 0:16:32And my sugar levels have gone right down to normal levels,
0:16:32 > 0:16:34which are about six.
0:16:34 > 0:16:36Have you spotted a difference in him?
0:16:36 > 0:16:38A big difference, yeah.
0:16:38 > 0:16:39In what way?
0:16:39 > 0:16:42Well, he seems a lot happier since he's been doing it.
0:16:42 > 0:16:44Really proud of him, he's done really well.
0:16:44 > 0:16:46What's been the most difficult thing?
0:16:46 > 0:16:50I think mainly the planning of meals.
0:16:50 > 0:16:55Not having the same repetitive stuff every day, you know?
0:16:55 > 0:16:59One person who's already achieved success is Alan Donaldson.
0:16:59 > 0:17:05We can step outside and walk the hills and get our exercise.
0:17:05 > 0:17:08He reversed the threat of diabetes after blood tests three years ago
0:17:08 > 0:17:11by dramatically changing his diet.
0:17:11 > 0:17:15I found Roy Taylor's work brilliant work and, within ten weeks,
0:17:15 > 0:17:18I'd lost a load of weight and my blood sugar was normal.
0:17:18 > 0:17:20Ten weeks.
0:17:20 > 0:17:23My mind controls what I eat now, not my eyes and my stomach.
0:17:24 > 0:17:27The next stage for you, exercise.
0:17:27 > 0:17:33Because that is what I do every day now.
0:17:33 > 0:17:36I mean, I felt really encouraged by what I've heard from you.
0:17:36 > 0:17:40It just gives us the motivation to carry on, you know?
0:17:40 > 0:17:42Ted, do you just want to come through?
0:17:42 > 0:17:43Yeah.
0:17:43 > 0:17:44Eight weeks are up.
0:17:44 > 0:17:45Ed is back at the surgery.
0:17:45 > 0:17:47Has the diet made a difference?
0:17:47 > 0:17:50That is 50 inches.
0:17:50 > 0:17:53You were 57 inches, now you're down to 50.
0:17:53 > 0:17:55That is seven inches of your waist.
0:17:55 > 0:17:56Great.
0:17:56 > 0:17:57Which is fantastic.
0:17:57 > 0:17:58Yeah.
0:17:58 > 0:18:00Shall we do the big one now?
0:18:00 > 0:18:01Shall we do the weight?
0:18:01 > 0:18:02Yeah.
0:18:02 > 0:18:03So we were 126.
0:18:03 > 0:18:06And that is 118.
0:18:06 > 0:18:09So that, by my reckoning, is 8.6 kilograms lost,
0:18:09 > 0:18:14which is 1 stone, 5 lbs.
0:18:14 > 0:18:15Brilliant.
0:18:15 > 0:18:18I can tell you, I do feel lighter on my feet,
0:18:18 > 0:18:20and I feel more alert.
0:18:20 > 0:18:24Best of all, Ed's blood sugar levels have fallen dramatically,
0:18:24 > 0:18:28close to a point where he can say he is free of the disease.
0:18:28 > 0:18:31We are still saying you are diabetic, but it is reversing.
0:18:31 > 0:18:32It is reversing.
0:18:32 > 0:18:34Like I said before, it is working.
0:18:34 > 0:18:36Absolutely.
0:18:36 > 0:18:38Ed has given himself something to smile about and has now
0:18:38 > 0:18:42increased his calorie intake to healthy, normal levels.
0:18:42 > 0:18:45But that is the real challenge in the months and years to come,
0:18:45 > 0:18:47to stay away from the bad food habits that
0:18:47 > 0:18:55contributed to his diabetes.
0:18:55 > 0:18:58For the time being, many experts believe it is impossible
0:18:58 > 0:18:59to reverse Type Two diabetes.
0:18:59 > 0:19:01For them, Professor Taylor's views are medical heresy,
0:19:01 > 0:19:05and there is a long way to go before he will convince them otherwise.
0:19:05 > 0:19:07I think we are winning the battle.
0:19:07 > 0:19:11We expected to be a years before it becomes widely accepted.
0:19:11 > 0:19:14We hope it will become part of routine treatment,
0:19:14 > 0:19:17but that depends upon the results of the study which is
0:19:17 > 0:19:25currently under way.
0:19:25 > 0:19:28For patients with Type 2 diabetes, managing their condition
0:19:28 > 0:19:32through stringent diets can be incredibly challenging,
0:19:32 > 0:19:34so what about more drastic measures?
0:19:34 > 0:19:38Well, a top international surgeon has told Inside Out London that far
0:19:38 > 0:19:42more people should be offered bariatric weight-loss surgery.
0:19:42 > 0:19:46He claims it's the closest thing we have to a cure and the most
0:19:46 > 0:19:49cost-effective way for the NHS to treat type two diabetics.
0:19:49 > 0:19:56We sent along Dr Ranj Singh to find out more.
0:19:56 > 0:20:00David Benge weighs 21 and a half stone and has Type 2 diabetes.
0:20:00 > 0:20:09I was diagnosed about seven years ago.
0:20:09 > 0:20:10Since then, my diabetes has deteriorated.
0:20:10 > 0:20:13His blood sugar levels are no longer being controlled.
0:20:13 > 0:20:15It affects my extremities, so my fingers and my toes
0:20:15 > 0:20:16particularly at night time.
0:20:16 > 0:20:19I do have difficulty getting to sleep, because my toes
0:20:19 > 0:20:20are fizzing and vibrating.
0:20:20 > 0:20:22It's painful.
0:20:22 > 0:20:25David used to be more positive than he has been of late.
0:20:25 > 0:20:27I think, with the health issues and the weight gain,
0:20:27 > 0:20:30it drags you down and makes you feel less positive about yourself and how
0:20:30 > 0:20:32other people might perceive you.
0:20:32 > 0:20:33But all this is about to change.
0:20:33 > 0:20:35It's the start of a new life.
0:20:35 > 0:20:36It's like being reborn.
0:20:36 > 0:20:38Today, here at Kings College Hospital, David
0:20:38 > 0:20:40is undergoing surgery, with the aim of putting his
0:20:40 > 0:20:45diabetes into remission.
0:20:45 > 0:20:48I've just had a discussion with the professor, who has actually
0:20:48 > 0:20:50informed me that I come off my medication directly
0:20:50 > 0:20:52after the operation, because it should be
0:20:52 > 0:20:53in remission straight away.
0:20:53 > 0:20:55Professor Francesco Rubino is carrying out the operation.
0:20:55 > 0:20:58He has been researching the effects of bariatric surgery on Type 2
0:20:58 > 0:21:00diabetes for 15 years.
0:21:00 > 0:21:06This is the most effective intervention that we have today.
0:21:06 > 0:21:08The operation, a gastric bypass, was originally used
0:21:08 > 0:21:09to treat stomach ulcers.
0:21:09 > 0:21:11Then, it became an obesity treatment.
0:21:11 > 0:21:20Now, it is proving a lifesaving operation for Type 2 diabetes.
0:21:34 > 0:21:37The operation is all done by keyhole surgery, which is safer and less
0:21:38 > 0:21:39invasive for the patient.
0:21:39 > 0:21:41Bariatric operations for diabetes are among the safest form
0:21:41 > 0:21:45of surgical operations we have today.
0:21:45 > 0:21:47During the operation, the stomach is permanently divided,
0:21:47 > 0:21:50using stitches, to create a new small stomach pouch.
0:21:50 > 0:21:52The small bowel is then measured, divided and brought up
0:21:52 > 0:21:55to permanently join the pouch.
0:21:55 > 0:22:00The redundant stomach and small bowel are reattached further down.
0:22:00 > 0:22:02The stomach is now divided in two portions.
0:22:02 > 0:22:05The food will not be able to go anymore in this part
0:22:05 > 0:22:10of the stomach and this part is now completely bypassed.
0:22:10 > 0:22:12The operation puts diabetes into remission by altering
0:22:12 > 0:22:15the hormones in the gut which, in turn, influences
0:22:15 > 0:22:18insulin production.
0:22:18 > 0:22:21The stomach and the intestine are an important organ for
0:22:21 > 0:22:23the regulation of sugar metabolism.
0:22:23 > 0:22:27So, altering the anatomy of those resets the metabolism of glucose
0:22:27 > 0:22:29and sugar and this is why we see such dramatic
0:22:29 > 0:22:32improvement of diabetes.
0:22:32 > 0:22:35At the moment, around 90% of people who have this procedure will get
0:22:35 > 0:22:38better control of their condition.
0:22:38 > 0:22:42Even more importantly, up to 60% will see a remission
0:22:42 > 0:22:44in their diabetes.
0:22:44 > 0:22:47It is ?6,000 per operation, but that is a small cost,
0:22:47 > 0:22:51compared to a lifetime of treatment and related illness.
0:22:51 > 0:23:01Yet, despite this success, only 1% of eligible people are offered it.
0:23:03 > 0:23:06I think many GPs don't know this surgery is an excellent
0:23:06 > 0:23:07option to treat diabetes.
0:23:07 > 0:23:10I don't think this is yet perceived as a life-saving
0:23:10 > 0:23:11operation, as it is.
0:23:11 > 0:23:14Current recommendations state only Type 2 diabetes patients with a BMI
0:23:14 > 0:23:17of above 30 are suitable for this operation.
0:23:17 > 0:23:23However, not all patients with this disease are overweight.
0:23:23 > 0:23:24Barbara was initially refused surgery because
0:23:24 > 0:23:26she was not fat enough.
0:23:26 > 0:23:30I suffer from a very rare, non-obese metabolic disease, called
0:23:30 > 0:23:33familial partial lipodystrophy.
0:23:33 > 0:23:35What that means is I have an inability to store fat,
0:23:35 > 0:23:39so it goes into the liver, pancreas and muscles which are not
0:23:39 > 0:23:45capable of storing fat and causes complete disfunction in them.
0:23:45 > 0:23:50Her condition caused her to develop Type 2 diabetes.
0:23:50 > 0:23:54Over 100 units of insulin a day made no change to the condition.
0:23:54 > 0:24:00I was getting worse.
0:24:00 > 0:24:02Barbara paid for a private consultation with Professor Rubino.
0:24:02 > 0:24:04She decided a gastric bypass was her only option.
0:24:04 > 0:24:07Eventually, the NHS agreed to fund it.
0:24:07 > 0:24:09Barbara is now one month after surgery and I think
0:24:09 > 0:24:10she is doing extraordinarily well.
0:24:10 > 0:24:16Most importantly, she has come off the insulin three or four days
0:24:16 > 0:24:19after the operation and, ever since, she has maintained
0:24:19 > 0:24:24improved blood sugar levels.
0:24:24 > 0:24:27Professor Rubino is now calling for guidelines to change.
0:24:27 > 0:24:30He says BMI should not be the only consideration.
0:24:30 > 0:24:34Now we know surgery can also be a diabetes treatment and so,
0:24:34 > 0:24:39I think, there is a need for NICE to update the diabetes guidelines.
0:24:39 > 0:24:43We put Professor Rubino s concerns to the Director of Policy for NICE,
0:24:43 > 0:24:53Professor Mark Baker.
0:25:04 > 0:25:07NHS England told us that, "Bariatric surgery should only be
0:25:07 > 0:25:09considered for severe obesity, where other approaches have
0:25:09 > 0:25:12not been successful."
0:25:12 > 0:25:14It may seem like a revolutionary treatment, but not
0:25:14 > 0:25:15everyone is suitable.
0:25:15 > 0:25:19However, David is one of the lucky ones.
0:25:19 > 0:25:25It's now two weeks since the procedure.
0:25:25 > 0:25:28My sugar levels have come down, naturally, so it's been superb.
0:25:28 > 0:25:29Are you glad you had the operation?
0:25:29 > 0:25:30Absolutely.
0:25:30 > 0:25:36It's just got better and better.
0:25:36 > 0:25:39Dr Ranj Singh with that story.
0:25:39 > 0:25:42Well, that's it from Inside Out for this week.
0:25:42 > 0:25:44Join the teams across England on Monday evening, 7:30pm, BBC One,
0:25:45 > 0:25:47for more stories from your area.
0:25:47 > 0:25:55Goodbye.
0:25:55 > 0:25:57And if you've been affected by the issues raised in this