Every 5th Indian is a diabetic. Obesity along-with diabetes is one of the fastest growing epidemics in today’s day and age. Both, obesity and diabetes are chronic progressive diseases. As diabetes progresses over the years, it has detrimental effects on eyes, nerves, blood vessels, heart and kidney. Obesity and diabetes together form a leading cause of death due to non-communicable diseases. Recently a new specialty called “metabolic surgery” has come to the fore and has proved to be an effective treatment option for obese patients suffering from diabetes.
Metabolic surgery is a type of advanced gastro-intestinal surgery which is done primarily for the treatment of type 2 diabetes in patients who are obese. It entails reduction of stomach size using staplers and sometimes re-routing of small intestines. This is performed through key-hole surgery which entails 4 to 5 tiny puncture marks on the abdomen. It can also be done through a “single-incision” in selected patients.
The American Diabetes Association recommends “metabolic surgery” as treatment option for diabetic patients with grade 2 obesity (BMI 32.5 to 37.5 kg/m2) and grade 3 obesity (BMI ≥ 37.5 kg/m2).
Patients with grade 1 obesity (BMI 27.5 to 32.5 kg/m2) may be recommended for “metabolic surgery” if they have uncontrolled blood sugars despite optimum medical management.
Yes, “metabolic surgery” has now been accepted as a valid treatment option for obese diabetics by multiple international diabetes associations. Infact, metabolic surgery is now a part of the treatment algorithm of diabetes as recommended by the American Diabetes Association.
There are various mechanisms by which metabolic surgery helps to lose leads to improvement in type 2 diabetes. Reduction in food intake leads to caloric restriction, weight loss, bypassing the first part of intestine, early delivery of food into the distal intestine, diversion of bile acids and alteration in gut flora are a few of the mechanisms that improvement in type 2 diabetes.
80 to 90% patients experience improvement or remission of type 2 diabetes after metabolic surgery. However, the degree of improvement depends on many factors. Age of the patient, duration of diabetes, body mass index at the time of surgery and c-peptide levels are indicative of how much improvement can be expected post- surgery. It is generally seen that patients with shorter duration of diabetes and higher weight tend to get better results.
Depending on the above factors, a significant number of patients do not need any medications for diabetes post-surgery and the remaining experience reduction in drug dosages.
Apart from the usual contra-indications for any surgery like being unfit for anesthesia etc, patients with type 1 diabetes generally do not benefit from metabolic surgery. Pregnant patients, smokers and those with severe psychiatric issues are also not eligible.
Metabolic surgery helps in blood sugar control along-with weight-loss. It is important to follow a good life-style and diet post the surgery. In the long term some patients may experience an increase in the blood sugar levels and hence it is important to keep the weight in check. Regular exercise, healthy diet and regular follow up with the endocrinologist are the key to success. On the road to recovery the medical team and the patient are partners and the success of any treatment depends on how invested both are in the care.
Bariatric and Laparoscopic Surgeon
Global Hospital, Parel; Apollo group of hospitals; Currae Hospital, Thane; Namaha and Suchak Hospitals, Kandivali