in Britain, the National Health Service spends 10 billion pounds per year treating it,

在英國，國民保健署每年花費 100 億英鎊來治療糖尿病，

that's almost 10% of the entire National Health budget.

這幾乎是整個國民保健預算的 10%。

By 2040, it's estimated that one in 10 people around the world will have the disease,

估計到了 2040 年，全世界每十人中就有一人罹患糖尿病，

three decades of healthy lifestyle advice have failed to make an impact.

三十年的健康生活方式建議未能產生影響。

Could surgery be the answer?

手術可能會有答案嗎？

Been a fisherman all my life.

我一生都是漁夫。

I can't tell you how much I miss the sea,

我無法告訴你我有多想念大海，

I love my wife and children obviously,

我當然也愛我的妻子和小孩，

but fishing is a passion, it isn't just a job.

但捕魚是種熱情，它不只是份工作。

Peter Hansell is 68.

彼得·韓塞爾今年 68 歲。

A few years ago, he was diagnosed with type two diabetes.

在幾年前，他診斷出罹患第二型糖尿病。

When I was diagnosed, I didn't think it would have the restrictions it had on my life,

當診斷結果出來時，我認為它不會對我的生活造成任何限制，

it just wasn't safe for me to be at sea,

不過在海上會不安全，

so diabetes has stopped me working, which upsets me greatly.

所以糖尿病讓我無法工作，這搞得我很不適應。

Type two diabetes is a serious condition in which the body can't use insulin properly,

第二型糖尿病是種嚴重的疾病，身體會無法正常使用胰島素，

90% of people with diabetes have type two,

90％ 的糖尿病患者都是第二型，

type one is much rarer and usually develops in childhood.

第一型是相當罕見的，通常會在童年時期發展。

The prognosis is that parts of my body will deteriorate over time, my kidneys, my heart.

預斷結果是，我身體的一部分會隨著時間而惡化，我的腎臟，我的心臟。

I've always had tons of get up and go,

我總是幹勁十足，

but I'm afraid the get up and go has got up and gone.

但我怕我的幹勁會筋疲力盡。

Globally the number of people with type two diabetes has quadrupled in the past four decades,

全球罹患第二型糖尿病的人數，與過去四十年相比多了四倍之多。

it's been branded as a lifestyle illness brought on by poor diet and lack of exercise.

通常認為糖尿病是種文明病，是由飲食不良和缺乏運動所造成。

Obesity is a major risk factor,

肥胖是主要的風險因素，

but one doctor is convinced that the disease is misunderstood.

但是，有名醫生確信這疾病受到大眾誤解。

If it were as simple as telling people to eat less and exercising more,

如果這疾病真的那麼簡單，那就告訴大眾少吃多動，

we have been giving this message for the past 30 years

過去 30 年來，我們一直在傳達這資訊，

and as a result, we haven't seen any change and the epidemic has continued to grow.

結果，我們卻沒看到任何變化，疫情仍繼續增長。

Professor Francesco Rubino specializes in weight loss surgery,

弗朗切斯科·魯比諾教授專攻減重手術，

he's performed hundreds of gastric bypass operations on obese patients, but Rubino has discovered that gastric surgery has a profound and unexpected side effect.

他對肥胖患者動過數百次的胃繞道手術，但魯比諾發現胃部手術有強烈且意想不到的副作用。

I found that many of the patients, who have bariatric operations would experience a complete remission of diabetes almost overnight,

我發現很多動了減肥手術的患者，在一夜之間會對糖尿病完全緩解，

to me, that was too much to be explained by weight loss alone and I thought what if there is something else?

對我來說，只靠減重手術還不足以解釋清楚，而且我想如果是因為其他因素所導致呢？

Dr. Rubino is now going to operate on Peter,

魯比諾醫生現在要對彼得動手術，

not because he's obese, but to treat his diabetes by changing the anatomy of his gut.

不是因為他的肥胖問題，而是要透過改變腸道結構來治療糖尿病。

Rubino believes that a section of the small intestine doesn't work properly in people with diabetes.

魯比諾相信罹患糖尿病的人，在他們小腸中有個部分沒有正常運作。

Peter's stomach will be divided and rerouted,

彼得的胃將受到隔開並重新改變路線，

so that food no longer passes through the faulty section.

這樣食物再也不會經過受損的部分。

Something happens in the duodenum,

十二指腸內出了一些問題，

which contributes to the mechanism of diabetes and by bypassing that segment, we're bypassing what could be the source of the problem.

從而導致出糖尿病的致病機制，只要繞過這個部分，我們繞過的可能是問題根源。

When food moves through the small intestine,

當食物通過小腸時，

a complex hormone signaling system tells the brain to stop eating and stimulates the pancreas to produce insulin.

複雜的賀爾蒙信號系統會告訴大腦，停止進食並刺激胰臟分泌胰島素

A fault in this signaling system would make it extremely difficult for the patient to control their eating

信號系統中的缺陷會使患者非常難控制他們的進食，

and could explain why the body can't regulate insulin properly.

也能夠解釋為什麼身體無法正常管理胰島素。

Peter stands a very good chance of having a complete remission of diabetes

彼得非常有可能完全緩解糖尿病，

and this is an effect that was not even conceived as possible just until a few years ago.

這種結果直到近幾年才構想出來。

The effect is so striking, that in 2016,

這個結果非常引人注目，在 2016 年，

international medical guidelines were changed to include surgery as a main treatment option for some diabetes patients, but very few have come forward.

國際醫學指南做出改變，將手術作為某些糖尿病患者的主要治療，但幾乎沒有實際案例。

Despite the evidence, suggesting that these interventions are so effective and in many cases, they're lifesaving,

儘管有證據表明，這些介入措施是如此有效，在許多情況下，它們都是可以救生的，

there are probably .1 to 1% of individuals, who meet the criteria for surgery who actually have access to it.

但可能只有 0.1% 到 1％ 的人符合手術標準並可以實際使用。

Type two diabetes is widely viewed as a lifestyle disease, that patients can control on their own without the need for surgery,

第二型糖尿病普遍認為是種文明病，患者可以自身控制，沒有動手術的必要。

but Rubino believes this is a misconception.

但魯比諾相信這是誤解。

Having an operation is not an experience that everybody would be prepared to have,

手術不是每個人都準備好要進行的，

however the evidence we have so far has shown time and again,

然而，我們目前所擁有的證據都一再表明手術是必須的，

or once you have very severe obesity,

也就是說，一旦你過度肥胖，

changing your lifestyle alone is not going to bring the benefits that are needed.

單獨改變你的生活方式，並不會帶給你所需的好處。

In clinical trials,

在臨床試驗中，

Rubino is testing other ways to prevent food from interacting with the faulty section of the intestine,

魯比諾正在測試其他方法來防止食物與腸道的缺陷部分相互作用，

such as plastic tubing or eradicating cells from the gut wall.

例如塑膠管或從消除腸壁細胞。

The hope is that in the future, patients like Peter won't need to have invasive surgery.

希望在未來，如同彼得這樣的患者，將不需要進行侵入性手術。

Seven weeks after the operation and Peter's health has taken a dramatic turn.

手術後七週，彼得的健康狀況發生了巨大變化。

I just feel good, I can just do what I want, I've got a life again.

我就感覺不錯，我可以做想做的事，又充滿了生命力。

I can't thank Professor Rubino and his team enough for what they did for me,

我非常感謝魯比諾教授和他的團隊為我所做的一切，

I haven't took any insulin since.

從那以後我就沒有服用任何胰島素。

For now at least, Peter's diabetes is in remission.

至少現在，彼得的糖尿病正在緩解期。

Surgery alone can't halt the epidemic,

單靠手術無法阻止這種流行病，

diabetes rates are rising in almost every country,

幾乎每個國家的糖尿病盛行率都在上升，

but only a few have the resources for surgery.

但只有少數人有手術資源。

Prevention through better diet and lifestyle is vital,

透過改善飲食和生活方式來預防是至關重要的，

but if surgery can uncover the cause of diabetes, perhaps a cure will follow.

但如果手術可以揭開糖尿病的病因，也許未來就會有治愈方法。