Tuesday, 24 November 2020

Can metabolic surgery tackle diabetes in India?

16 November 2020 | Views

The Manipal hospitals urge us to take a step forward to stop diabetes in our country by spreading awareness about ways to tackle the disease through surgery

Image source: Shutterstock

Image source: Shutterstock

India is witnessing a steady upsurge of lifestyle disorders of obesity and type 2 diabetes mellitus (T2DM), owing to genetic predisposition coupled with rapid urbanization, sedentary lifestyle and a westernized diet pattern. Today we rank third in the world for having the highest number of obese people. Unfortunately, 80% of these people, also suffer from diabetes. By 2030, diabetes is expected to take a toll on approximately 98 million people in the country. Ironically, we are also the global hotspot for type 2 diabetes.

In most cases of T2DM, hyperglycaemia occurs due to insulin resistance and metabolic syndrome. In metabolic syndrome, excessive fat in and around the abdomen, and high blood pressure can trigger diabetes. Additionally, diabetes acts as a host to many other diseases related to the cardiovascular system and kidneys. Diabetes being a progressive condition, such patient can eventually end up with frequent insulin injections and a handful of meds. This can become a painful routine for diabetics and their quality of life may get compromised. For such people, metabolic surgery may be the sweetest news they have heard in recent years. Metabolic surgery is a breakthrough surgery because it helps not just to manage diabetes, but to treat numerous complications associated with it, the most common being heart disease.

Metabolic surgery is a minimally invasive procedure and can effectively reverse symptoms in a person suffering from obesity and diabetes. In this surgical procedure, the person's stomach is made smaller so that he eats less. This in turn leads to weight loss and increases the sensitivity to insulin. Additionally, certain procedures of surgery affect the hormonal secretions in the gut and makes the person respond to food differently. Eventually, the changes brought in the way the patient’s body utilizes the blood sugars resulting in the reversal of T2DM.

For many obese patients with uncontrolled blood sugar, surgery is considered the last option to tackle diabetes. For somebody who needs to lose about 40-50 kg or more weight, the traditional lifestyle approaches/medications to lose weight may not be sufficient. These people may find hope at the end of the tunnel through metabolic surgery which is a safe option and the results are seen much faster. In fact, many scientific bodies and guidelines recommend bariatric surgery in the early treatment of diabetes in appropriate patients as it yields much better short- and long-term results as compared to lifestyle modification and optimum medicines, including insulin.

Lastly, but not least like any other surgery, bariatric surgery may be associated with risk related to anesthesia and the patient’s medical problems. However, if done in a well-equipped center by a good surgeon, it is extremely safe and the benefits associated with the surgery outweighs the risk in obese patients with diabetes.

Considering the cost of lifelong medications for managing diabetes and its frequent complications in a developing country like India, metabolic surgery is a blessing in disguise for many. Most importantly this is a safe and cost-effective surgery that could be considered early on in the battle against this lifestyle disease.

 

Dr Sumit Talwar, HOD and Consultant Bariatric Surgery and Dr Karthik Prabhakar, HOD, and Consultant in Diabetes and Endocrinology, Manipal hospitals

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