Diabetes is predominantly an intestinal disease

Diabetes mellitus (DM) is a chronic, progressive, medically incurable disease and is poorly controlled in a vast majority, in spite of tremendous advancements in pharmacotherapy. Altered gut microbiome can predict diabetes. There is strong and consistent evidence regarding role of the gut and many gut hormones like incretins in energy and glucose homeostasis. Incretin group of agents including glucagon-like peptide (GLP-1) receptor agonists and dipeptidyl peptidase IV (DPP-IV) inhibitors are efficacious therapeutic agents in diabetes treatment. A growing body of evidence, however, appears to indicate that type 2 DM (T2DM) may be an operable intestinal illness—a novel revolutionary concept about an old disease. This may facilitate research that can better clarify our understanding of the etiology of the disease and provide a new opportunity to develop new and more effective therapies. Future research should focus on an approach to bypass the bypass, that is, to replace the gastric bypass by equally effective but less invasive treatments for majority of diabetics.