Surgery for Diabetes

  • Metabolic and bariatric surgery for diabetes has emerged as a boon for patients suffering for type 2 diabetes. In fact , all over the world it has been recognized as the only treatment modality which can offer a permanent cure to this chronic, progressive, silent killer disease diabetes.
  • Diabetes  leads to many health problems including cardiovascular or heart  disease, stroke, blindness, kidney failure, neuropathy, amputations, impotency, depression, cognitive decline and mortality risk from certain forms of cancer.
  • Conventional therapy for type 2 diabetes includes lifestyle modification (weight-loss, appropriate diet, exercise) and anti-diabetes medications but diabetes often worsens with time, requiring even greater numbers of medication or a higher dosage to keep blood sugar under control.
  • Obesity is considered a major contributing factor in the development of diabetes to the extent that 80%of the diabetics are obese.

Results of surgery for diabetes

  • Surgery  for diabetes is  a quick and easy way to get rid of the disease altogether. Metabolic surgery promises to reverse type 2 diabetes, and help you go back to living life to the fullest. Metabolic surgery promises to reverse type 2 diabetes, and help you go back to living life to the fullest.
  • Over 80 % of the patients after the surgery will have normal blood sugar without medicines which is very significant because worldwide 60% of patients have uncontrolled blood sugar levels even with medicines. Bariatric surgery even prevents development of diabetes in severely obese, non-diabetic patients.
  • In addition to impressive antidiabetic effects, these weight loss surgeries cause complete resolution of high blood pressure or hypertension, improvement of dyslipidemia and overall survival.

Types of operations

  • After  evaluation of patients, depending upon the duration and severity of diabetes and other comorbidities, the best suitable surgery tailored according to the need of the patient is offered to the patient.Among several surgeries available, the most popular for diabetes associated with obesity are:

         Roux en Y Gastric Bypass

         Mini Gastric Bypass

         Sleeve Gastrectomy

  • There are 15-20% of patients who are not obese but suffering from diabetes. Several novel procedures aimed at treating diabetes and not to reduce weight have been developed in recent years. These procedures are meant mainly to control diabetes in individuals who are normal weight or non-obese. Two procedures that are commonly performed:

         Laparoscopic Duodenojejunal Bypass

         Laparoscopic Sleeve Gastrectomy with Ileal Interposition

Results of Surgery for Diabetes

ROUX-EN-Y GASTRIC BYPASS
The operation results in significant weight-loss and causes remission of T2DM in 80 percent of patients and improvement of the disease in an additional 15 percent of patients. Till date, the best procedure for diabetes control and remission.

SLEEVE GASTRECTOMY
Diabetes remission rates after sleeve gastrectomy are also very high (more than 60%) and, in some studies, similar to results seen after gastric bypass. However, in long standing diabetes, standard gastric bypass still the most acceptable procedure.

Mini Gastric Bypass
The MGB is more of a malabsorptive procedure and has become extremely popular both in terms of less complications and results equally good or even better for diabetes remission when compared to gastric bypass.

FAQs

Why earlier the surgery better the outcome in terms of diabetes remission?
It is now well documented that shorter the duration of diabetes, higher are the chances for complete resolution. In long term diabetes because of glucose toxicity, there is accelerated B cell destruction (these beta or B cells situated in pancreas produce insulin). These B cells are the cells that produce insulin. Surgeries performed before irreversible death of these cells can cause complete resolution of diabetes.

What is metabolic syndrome?
Metabolic syndrome is a group of diseases that when occurring together lead to diabetes and heart disease. This usually include obesity, excessive fat around the stomach, high blood pressure, high levels of LDL or bad cholesterol and low levels of HDL or good cholesterol.

How does metabolic surgery fit in here?
Metabolic surgery is a minimally invasive procedure performed through 4-5 tiny incisions on your abdomen. The metabolic and physiological changes that occur after surgery helps in nullify all the factors that lead to metabolic disease; thereby reversing conditions like diabetes, PCOD and many heart diseases.
The surgery brings out many desirable hormonal changes that leads to effective management of diabetes and its complications.

If all the surgery does is help a person lose weight, why can’t the same not be done by following a diet and exercise regime?
While each and every patient attempts these modalities to bring desirable results but their attempts are almost unsuccessful. A person having uncontrolled diabetes if allowed to undergo dieting can have hazardous consequences, the inability to exercise for prolonged time due to age, other medical diseases or even obesity  becomes the obvious reasons for such high failure rates  . That is where this surgery comes into play. It gives  patient instant result in three to thirty days, making it a quick and safe way to tackle this disease.
Moreover, with diet and exercise a patient may not achieve complete reversal of the disease, while metabolic surgery can achieve complete remission in majority of the patients.

How long does the surgery last?
It is performed under general anesthesia with the help of laparoscopy – a minimally invasive procedure. At the end of the procedure the patient will have only three small incisions on the stomach and the recovery is fairly fast. The procedure takes about two hours to complete and the patient can go back to his/her normal life seven days after the surgery.

What type of  food and lifestyle modifications needed  following metabolic surgery?
Right after the surgery,  most of the medicines will not be required and there is a high possibility that gradually all medicines for diabetes and blood pressure will be stopped in a few days time.
However, patients need  to understand that certain dietary and life style modifications are required and they must adhere to foods with a low GI (glycemic index), exercise regularly and eat frequent, small and healthy meals. Our bariatric nutritionists will guide and help to implement these life style altercations in order to lead a healthy and normal life.
To conclude, imagine a life with no monitoring of blood sugar, no insulin injection or no fear of  complications of diabetes and living life to the fullest.

Who are eligible to undergo Metabolic Surgery?

Patients suffering from type 2 diabetes and are obese

  • aged between 18 to 65 years
  • duration of diabetes > 3 years and < 20 years
  • not losing weight in the past 1 year
  • stable diabetes in the past 3 months
  • post prandial serum C – peptide levels > 0.9 ng/ml
  • BMI ≥ 30 kg/m2

For non-obese Indians (Normal weight – BMI < 23 kg/m2, Overweight – BMI ≥ 23 kg/m2 and < 25 kg/m2) we do metabolic surgery after taking detailed informed consent and taking ethical committee approval. Even in such patients cure from diabetes is quite high.

What factors affect the Cure of Type 2 Diabetes?
Several factors that might decide the result and success of surgery include duration of this disease, insulin requirement before surgery, age of the patient and amount of insulin produced in body at the time of surgery (beta cell mass).

What are the Investigations needed before Metabolic Surgery?
A thorough and complete patient evaluation is required  to ensure satisfactory results. It includes  cardiac and respiratory status of the patient which decides surgical fitness of the patient. We perform fasting and post prandial blood glucose levels, HbA1c, post prandial C – peptide and Anti GAD antibody levels.

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