One of the commonest disease of modern times – diabetes is affecting over 30 million Indians. Considered to be a lifetime problem, this affliction requiring permanent lifestyle changes & has been mentioned in ancient literature as well.
Diabetes has significant contribution in to other diseases like heart attacks, kidney failure, nerve damage with ulcers of feet & amputations, blindness etc. Patients of diabetes are known to silently suffer from this illness.
Additionally, patients are known to respond to drugs less & less with time, thus more drugs have to be added to ensure better sugar control. Even then majority of patients on regular follow up are not able to maintain the desired levels with resultant micro-vascular damage of organs like kidney, heart, eyes etc.
New insights by scientists in recent times have shown that the entire understanding of cause of diabetes may undergo dramatic change in near future. Contrary to popular perception, Type 2 Diabetics have excess of insulin production capacity but this insulin proves ineffective in presence of certain unidentified changes in body. These changes are thought to be end result of actions of hormones (called incretins) secreted by the intestinal lining in response to food intake.
Raised incretin levels were noticed in post gastric bypass patients whose sugar levels returned to normal within 1 month of surgery. These patients did not require anti-diabetes medicines(tablets or insulin injections) even 10 years after surgery. Over 82% diabetes patients undergoing this surgery had resolution of disease. They were able to maintain normal sugar levels even without lifestyle restrictions imposed by the disease. It is known that sustained control of sugar levels results in reduction of micro-vascular complications (read heart, kidneys, eyes & nerve diseases).
A Diabetes Surgery Summit was organized by American Diabetes Association, European Association for the Study of Diabetes etc at Rome, Italy in March 2007. It was attended by eminent physicians, researchers & surgeons from around the world. Available facts & figures from published literature were considered & a consensus statement was drafted with majority vote(>67%).
· It was accepted that in morbidly obese(>35 kgs overweight) gastric bypass is advisable to control weight & associated diabetes.
· Even in patients who are just obese, if diabetes is not well controlled with available medicines & lifestyle changes, surgery can be considered to achieve long term diabetes control.
· New surgical methods, involving only sugar control & no weight loss were evaluated & guidelines formulated for their clinical application.
So, the question is no more whether surgery can resolve diabetes – the overwhelming evidence available in medical literature & consensus statement leaves no well read physician in doubt.
We are performing surgeries for a lifestyle disease – obesity & treating diabetes incidentally. I am convinced that inadequately controlled diabetes patients would benefit from this knowledge for long term sugar control & related disease reduction.
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