Research Profile

Professor James Toouli of Flinders University

Expert in abdominal surgery, studying the potential of weight loss surgery to improve type 2 diabetes control in obese patients

“Treating obesity will improve the control of type 2 diabetes,” says Professor James Toouli of Flinders University in Adelaide, SA. For the past decade, the Professor of Surgery has studied obesity and weight loss procedures and his research has led to significant knowledge about the treatment of type 2 diabetes.

While surgery should only be undertaken when diet and exercise have failed to achieve weight loss, Professor Toouli has done extensive research into the effectiveness of adjustable gastric banding. This is where an inflatable band is surgically placed around the stomach to limit the amount of food the patient can eat, in an effort to achieve weight loss.

“We have found that the majority of patients who have adjustable gastric band surgery generally lose between 55 and 60 per cent of their excess weight. Patients with type 2 diabetes then see improved control across all markers – coming off insulin or needing less oral medication – as evidenced by a significant drop in HbA1c,” says Professor Toouli.

Earning his PhD at Monash University in Melbourne, Professor Toouli has been with Flinders University since 1976. He has been in clinical practice and research for over 30 years, at first specialising in other aspects of abdominal surgery, such as the pancreas, before turning his focus to weight loss surgery.

Twelve years ago, he and his team were the first to bring the Swedish Adjustable Gastric Band to Australia, one of the earliest types of gastric bands.

“At the time, gastric bypass surgery [where part of the stomach is stapled off to create a small pouch that is then connected to the intestine] was considered the gold standard of weight loss surgery,” he says.

“But since then, research has shown that while a gastric bypass initially achieves weight loss faster, after three years a gastric band is equally effective. Then there are the additional benefits that gastric banding is less invasive, more minimal and generally safer because the stomach is not physically altered.”

One of Professor Toouli’s latest trials will compare the results of gastric banding to diet suppressants and other medications in obese people with type 2 diabetes. The hypothesis is that gastric banding will be more effective in achieving weight loss and improved diabetes control.

Recently, there have been media reports claiming that gastric band surgery can ‘cure’ type 2 diabetes. This is a claim the professor flatly rejects. “This is a way to better control your diabetes, but the diabetes does not disappear after the procedure. It is definitely not a cure,” he says.

In some of their cutting-edge research, Professor Toouli and his team are also investigating a new technique where a pacemaker is connected to the vagus nerve, one of the major nerves involved in the digestive system. Initial research, only conducted in the past few years, suggests that sending electrical impulses into the nerve can intermittently turn it on and off, slowing down digestion and making the patient feel less hungry, eat less and feel full faster.

This technique does not harm the patient and early indications suggest it may be just as effective as gastric banding in losing weight.

However, the most intriguing part of this procedure is that when done in patients with type 2 diabetes, they see marked improvements in their HbA1c and diabetes control even before they lose weight. With all other procedures, the improvement in diabetes control only comes after weight loss.

The researchers are investigating why this happens. “That is the $64,000 question,” says Professor Toouli, and they hope to have an answer by the end of this year.