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Diabetes and Bariatric Surgery

“Diabetes is looming as one of the greatest public health threats of the 21st century and it has a strong correlation with obesity. ‘Diabesity’, as we may call it is the fastest growing pandemic of the world and the Asian population seems to be the most affected”

 New Delhi:

Obesity is a no longer a laughing matter, it has reached alarming proportions in our urban society and needs serious attention. It is a fact that today the number of overweight people in the world is equal to the underweight population. What is adding fuel to the fire is the fact that this obesity brings with it hoards of other diseases like diabetes, hypertension, dyslipidemia, joint problems, sleep disorders, respiratory insufficiency, infertility, behavioral disorders and social stigma.

The Asian population is more prone to developing the Metabolic Syndrome as compared to their Caucasian counterpart at a lower BMI because:

  •       Higher magnitude of adiposity, abdominal obesity and lower muscle mass.
  • Truncal skin fold thicker meaning more subcutaneous fat.

Interestingly, higher level of hyperinsulinemia and related metabolic derangements has

been recorded in Asian Indian neonates and children as compared to white Caucasian neonates.

PIC

What has given us a jolt is a recent survey of the school going children in Delhi which states that 30% of them are overweight. Shockingly one third of them will develop Diabetes when they become adults.

 

Today diabetes is called the mother of all diseases. Various medicines are now available to control diabetes but still many patients are not adequately benefitted. What needs to be done for Diabesity after lifestyle management and all other medications fail is something more radical.

We have seen in our own clinic at Sir Ganga Ram hospital  that these obese individuals have a poor diabetes control and there insulin requirement keeps on increasing.

 

The only permanent and logical solution for managing obesity & type 2 diabetes endorsed by physicians, endocrinologists, nutritionists is BARIATRIC SURGERY.

 

Over the past few years active research is going on to evaluate the benefits of obesity surgery in curing diabetes. It has been observed over the years that various surgeries like Roux-en Y Gastric Bypass and now Sleeve Gastrectomy have remarkable beneficial effects on diabetes.

According to Dr Francesco Rubino of New York Presbyterian Hospital, USA “Surgery is an excellent approach for treatment of diabetes and metabolic disease”. Similarly The STAMPEDE TRIAL which is being conducted by Dr Philip Schauer et al at Cleveland Clinic, USA shows that surgical treatment of diabetes (with RYGB and Sleeve) was far more effective than insulin or drug treatment.

 

To see the effects of surgical treatment on diabetes, we at the Institute Minimal Access, Metabolic & Bariatric Surgery, Sir Ganga Ram Hospital, New Delhi analyzed on our data of more than 200 patients who underwent laparoscopic sleeve gastrectomy. We found 78% resolution of diabetes, 62% resolution of hypertension and over 90% resolution of sleep disorders. The ‘Quality of life’ index improved from 2.7 to 8.2 (on a scale of 1-10). Our patients now have seen and hence agree to the remarkable benefits that surgery had on their diabetes.

 

Conclusion: These initial results are very encouraging, but a longer follow up would be required to substantiate our belief. We are currently in phase one of a clinical trial where a systematic analysis of various gut hormones before and after surgery is being done. World data is now available to suggest more than ever before that diabetes is more a disease of the gut. The management of Diabetes would need a very radical and different approach.

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