Bariatric Surgery can help treat Diabetes

Bariatric Surgery can help treat diabetes?

In the past few decades, Type 2 diabetes has quietly spread across our nation affecting nearly 50 million people and giving India the dubious distinction of being the “diabetes capital of the world”. Due to the lack of awareness about the disease and misconceptions about its management, a large number of people suffer from avoidable complications.

Living with Diabetes

Diabetes is characterised by the inability of body cells to properly utilize the metabolic hormone insulin. Insulin is important in controlling levels of blood sugar and diabetes can be caused either when the body is unable to produce enough insulin (Type 1) or when the target cells are unable to utilise insulin (Type 2) produced by the body. This results in too much glucose building up in the blood.

Type 1 Diabetes is a less common form of diabetes and is believed to be governed by genetic factors and infections while Type 2 Diabetes is more commonly found in adults and is considered a consequence of poor lifestyle choices such as erratic eating habits, sedentary lifestyle and weight gain.

A major factor linked to Type 2 Diabetes is obesity. Studies have shown that individuals who are obese (Body Mass Index between 28-38) or morbidly obese (BMI>38) are at an increased risk of developing Type 2 Diabetes and other co-morbidities like cardiovascular disease, infertility, hypertension, sleep apnea, liver diseases, depression and osteoarthritis. Obesity has long been considered a disease of the West and of the affluent classes, whereas the truth is that if affects nearly 1 in 5 males and 1 in 6 females in our country.

Diabesity

Putting on excess weight not only damages the musculo-skeletal  tissues by exerting physical stress on them but also disrupts the delicate hormonal balance and other important regulatory chemicals in the body. A high percentage of fat in the body negatively impacts the ability of cells to utilise insulin and hence their ability to metabolize blood glucose. This imbalance stimulates the pancreas to produce more insulin to try and compensate, thus giving rise to a Hyperinsulinaemia prior to the patient turning Diabetic.

Recent studies show, that aggressively treating obesity can not only help diabetics manage their sugar level better but in a large number of cases allow for complete reversal of type 2 diabetes. The International Diabetes Federation reported that the number of diabetics around the world is set to grow from 258 million to 438 million within the next 20 years and patients who are obese and diabetic should consider bariatric surgery as a treatment option for type 2 diabetes. For individuals who are morbidly obese or have a BMI greater than 33 and are suffering from one or more co-morbidities associated with obesity, bariatric surgery is the only viable and safe option for permanent weight loss. These severely obese patients find it impossible to lose weight through diet and exercise alone. There are various types of surgeries available of which the most popular ones are Sleeve Gastrectomy and Gastric Bypass surgery.

• Sleeve Gastrectomy is a laparoscopic surgery wherein the stomach capacity is permanently reduced to 25 percent of its original size. This is purely a restrictive procedure.

•  Gastric bypass is also a laparoscopic procedure, where food is diverted away from the stomach into the small intestine. This is both restrictive and malabsorptive procedure.

Bariatric surgery has been clinically proven as the most appropriate treatment of choice, to achieve sustainable weight loss in obese diabetic patients and to help restore the hormonal balance. More than 90 percent diabetic patients are able to completely reverse their diabetic tendency as a result of bariatric surgery and the remainder are able to drastically reduce their diabetes medication. This is a highly economical option for patients, as the cost of the surgery is easily offset within a couple of years due to the reduction in the cost of medication and treatments required for obesity related illnesses.

Post bariatric surgery patients need a sensible diet and lifestyle to maximize the positive effects of surgery. All co morbidities related to obesity will resolve or substantially improve as patient loses weight over a period of 15 to 18 months.

Thus diabetes is a treatable condition and the complications associated with it can be easily avoided by being aware of one’s condition and taking corrective measures in a timely manner.

Dr Ravindran Kumeran