Bariatric solution for curing diabetes offers new hope

Fifty two year old Patient Manju had been diabetic for 15 years. Her disease was uncontrollable and her blood sugar was never controlled. She was taking 32 units of Insulin plus oral anti-diabetic tablets. Just when she had given up all hope, doctors suggested bariatric surgery to cure the condition. Just 2-3 weeks after the procedure, her insulin requirement went down gradually with low sugar level. She was 127 kg before surgery and now after 1 year of surgery she has lost 55 kg of weight and she is off all the medications.

The twin epidemics of type 2 diabetes and obesity are emerging as a big public health challenge for India. There are over 65 million diabetes patients in the country, with another 30 million or so in the pre-diabetes group. In the next 15 years, we will be hosting the biggest number of diabetics in the world. Obesity has also reached alarming proportions, with morbid obesity affecting 5% of India’s population. Indians have been shown to be genetically susceptible to gaining weight, especially around the waist.

Both the conditions feed on each other and are a result of the modern, sedentary lifestyle, fuelled by a high-fat, energy-rich diet. These causes extra stress on the human body and increase the risk of premature death. Serious health conditions may arise, reducing the overall quality of life. Diabetes neuropathy can cause serious problems like heart disease, strokes, blindness, kidney failure and amputation. Obesity is associated with high blood pressure, diabetes, heart diseases, respiratory problems, depression, infertility, arthritis and certain types of cancer.

For obese or not-so-obese people whose blood sugar levels are way out of control, bariatric surgery offers a new ray of hope. The procedure is designed to make patients lose weight by making changes to their digestive system so that they eat less, and absorption of nutrients by the body is drastically reduced. Surgery results in removal of ghrelin receptors responsible for Diabetes Mellitus and also affect gut hormones which are responsible for Glycemic Control. It can provide a more effective and long-lasting treatment for diabetes and obesity than the standard therapies of drugs, diet and exercise.

Gastric bypass is the most popular type of bariatric surgery because it generally has fewer complications than other weight loss surgeries. In this, the size of the stomach is made smaller and food is made to bypass part of the small intestine (where most of the nutrients and calories are absorbed). As a result, the person feels full after eating much smaller quantities of food, leading to weight loss. Bariatric surgery can be done through a small incision (laparoscopy).

With advances in science, it is today considered one of the safest surgical procedures of the abdomen. The patient is usually discharged 24 hours after surgery.

The National Institutes of Health (NIH) of the US Government has recognized bariatric surgery as the only effective treatment to combat severe obesity and maintain weight loss in the long term which is recommended if the body mass index (BMI) is 36 or higher, or if it is more than 32 with uncontrolled diabetes. Bariatric surgery results in significant weight loss (up to 97% of the excess weight) that can be sustained over years. Only 10% of the patients gain excess weight after bariatric surgery compared to 98% who reduce weight through diet and exercise.

Research reveals that bariatric surgery can also keep diabetes at bay for many years and even reverse some of the health complications. The improvement in diabetes control is usually long lasting, with normal insulin levels returning within days of the surgery, long before any significant weight loss takes place.1 Many medical experts are now recommending bariatric surgery as an early treatment option for people with uncontrolled diabetes.

A study by Cleveland Clinic published in September 2013 in the journal, Annals of Surgery, showed beneficial long-term effects of bariatric surgery for people with diabetes. It discovered that obese patients with type 2 diabetes continue to experience the benefits of bariatric surgery up to nine years after the procedure. During this period, they continued to improve or reverse their diabetes, as well as lower their cardiovascular risk factors.

The researchers identified long-term weight loss and a short duration of diabetes before surgery as among the main factors that resulted in higher rate of long-term diabetes remission. They concluded that bariatric surgery can offer durable remission of diabetes in some patients and should be considered as an earlier treatment option for patients having problems in controlling their diabetes.

Surgical cure of obesity and diabetes is now in the realm of reality. Thousands of patients have benefited by drastically reducing weight and naturally controlling their blood sugar levels through bariatric surgery.

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